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Methods of intraperitoneal local anaesthetic instillation for laparoscopic cholecystectomy.

作者信息

Gurusamy Kurinchi Selvan, Nagendran Myura, Toon Clare D, Guerrini Gian Piero, Zinnuroglu Murat, Davidson Brian R

机构信息

Department of Surgery, Royal Free Campus, UCL Medical School, Royal Free Hospital, Rowland Hill Street, London, UK, NW3 2PF.

出版信息

Cochrane Database Syst Rev. 2014 Mar 25;2014(3):CD009060. doi: 10.1002/14651858.CD009060.pub2.


DOI:10.1002/14651858.CD009060.pub2
PMID:24668032
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10979524/
Abstract

BACKGROUND: Intraperitoneal local anaesthetic instillation may decrease pain in people undergoing laparoscopic cholecystectomy. However, the optimal method to administer the local anaesthetic is unknown. OBJECTIVES: To determine the optimal local anaesthetic agent, the optimal timing, and the optimal delivery method of the local anaesthetic agent used for intraperitoneal instillation in people undergoing laparoscopic cholecystectomy. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, Science Citation Index Expanded, and the World Health Organization International Clinical Trials Registry Platform portal (WHO ICTRP) to March 2013 to identify randomised clinical trials for assessment of benefit and comparative non-randomised studies for the assessment of treatment-related harms. SELECTION CRITERIA: We considered only randomised clinical trials (irrespective of language, blinding, or publication status) comparing different methods of local anaesthetic intraperitoneal instillation during laparoscopic cholecystectomy for the review. DATA COLLECTION AND ANALYSIS: Two review authors collected the data independently. We analysed the data with both fixed-effect and random-effects models using Review Manager 5 analysis. For each outcome, we calculated the risk ratio (RR) or mean difference (MD) with 95% confidence intervals (CI). MAIN RESULTS: We included 12 trials with 798 participants undergoing elective laparoscopic cholecystectomy randomised to different methods of intraperitoneal local anaesthetic instillation. All the trials were at high risk of bias. Most trials included only people with low anaesthetic risk. The comparisons included in the trials that met the eligibility criteria were the following; comparison of one local anaesthetic agent with another local anaesthetic agent (three trials); comparison of timing of delivery (six trials); comparison of different methods of delivery of the anaesthetic agent (two trials); comparison of location of the instillation of the anaesthetic agent (one trial); three trials reported mortality and morbidity.There were no mortalities or serious adverse events in either group in the following comparisons: bupivacaine (0/100 (0%)) versus lignocaine (0/106 (0%)) (one trial; 206 participants); just after creation of pneumoperitoneum (0/55 (0%)) versus end of surgery (0/55 (0%)) (two trials; 110 participants); just after creation of pneumoperitoneum (0/15 (0%)) versus after the end of surgery (0/15 (0%)) (one trial; 30 participants); end of surgery (0/15 (0%)) versus after the end of surgery (0/15 (0%)) (one trial; 30 participants).None of the trials reported quality of life, the time taken to return to normal activity, or the time taken to return to work. The differences in the proportion of people who were discharged as day-surgery and the length of hospital stay were imprecise in all the comparisons included that reported these outcomes (very low quality evidence). There were some differences in the pain scores on the visual analogue scale (1 to 10 cm) but these were neither consistent nor robust to fixed-effect versus random-effects meta-analysis or sensitivity analysis. AUTHORS' CONCLUSIONS: The currently available evidence is inadequate to determine the effects of one method of local anaesthetic intraperitoneal instillation compared with any other method of local anaesthetic intraperitoneal instillation in low anaesthetic risk individuals undergoing elective laparoscopic cholecystectomy. Further randomised clinical trials of low risk of systematic and random errors are necessary. Such trials should include important clinical outcomes such as quality of life and time to return to work in their assessment.

摘要

相似文献

[1]
Methods of intraperitoneal local anaesthetic instillation for laparoscopic cholecystectomy.

Cochrane Database Syst Rev. 2014-3-25

[2]
Intraperitoneal local anaesthetic instillation versus no intraperitoneal local anaesthetic instillation for laparoscopic cholecystectomy.

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[3]
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[5]
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[6]
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[7]
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引用本文的文献

[1]
Intraperitoneal local anesthetics for postoperative pain management following intra-abdominal surgery: a systematic review and meta-analysis.

BMC Anesthesiol. 2025-5-10

[2]
Compared the Effectiveness of Intraperitoneal Bupivacaine with Lung Recruitment Maneuver Versus Normal Saline with Lung Recruitment Maneuver in Reducing Shoulder Pain After Laparoscopic Surgery: A Double-Blind Randomized Controlled Trial.

Anesth Pain Med. 2024-7-14

[3]
Intraperitoneal local anaesthetic instillation versus no intraperitoneal local anaesthetic instillation for laparoscopic cholecystectomy.

Cochrane Database Syst Rev. 2021-10-25

[4]
Analgesic Efficacy of Bupivacaine or Bupivacaine-Dexmedetomidine After Intraperitoneal Administration in Cats: A Randomized, Blinded, Clinical Trial.

Front Vet Sci. 2019-9-13

[5]
Optimising Surgical Technique in Laparoscopic Cholecystectomy: a Review of Intraoperative Interventions.

J Gastrointest Surg. 2019-6-24

[6]
A comparative evaluation of pre-emptive versus post-surgery intraperitoneal local anaesthetic instillation for postoperative pain relief after laparoscopic cholecystectomy: A prospective, randomised, double blind and placebo controlled study.

Indian J Anaesth. 2019-3

[7]
Interest of Using Ropivacaine for Outpatient Laparoscopic Cholecystectomy: Prospective Randomized Trial.

World J Surg. 2017-3

[8]
Low vs Standard Pressures in Gynecologic Laparoscopy: a Systematic Review.

JSLS. 2016

本文引用的文献

[1]
Intraperitoneal local anaesthetic instillation versus no intraperitoneal local anaesthetic instillation for laparoscopic cholecystectomy.

Cochrane Database Syst Rev. 2014-3-13

[2]
Wound infiltration with local anaesthetic agents for laparoscopic cholecystectomy.

Cochrane Database Syst Rev. 2014-3-12

[3]
Routine abdominal drainage versus no abdominal drainage for uncomplicated laparoscopic cholecystectomy.

Cochrane Database Syst Rev. 2013-9-3

[4]
Intraperitoneal nebulization of ropivacaine for pain control after laparoscopic cholecystectomy: a double-blind, randomized, placebo-controlled trial.

Br J Anaesth. 2013-1-4

[5]
Industry sponsorship and research outcome.

Cochrane Database Syst Rev. 2012-12-12

[6]
Influence of reported study design characteristics on intervention effect estimates from randomised controlled trials: combined analysis of meta-epidemiological studies.

Health Technol Assess. 2012-9

[7]
Influence of reported study design characteristics on intervention effect estimates from randomized, controlled trials.

Ann Intern Med. 2012-9-18

[8]
The beneficial effect of transversus abdominis plane block after laparoscopic cholecystectomy in day-case surgery: a randomized clinical trial.

Anesth Analg. 2012-7-4

[9]
Intraperitoneal lignocaine (lidocaine) versus bupivacaine after laparoscopic cholecystectomy: results of a randomized controlled trial.

J Surg Res. 2012-6-22

[10]
Intraperitoneal ropivacaine nebulization for pain management after laparoscopic cholecystectomy: a comparison with intraperitoneal instillation.

Anesth Analg. 2011-9-14

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