Preemptive Local Anesthetic in Gynecologic Laparoscopy and Postoperative Movement-Evoked Pain: A Randomized Trial

To evaluate whether preemptive local anesthetics injected into the trocar areas reduce postoperative movement-evoked pain within an enhanced recovery program (ERP) in laparoscopic gynecologic surgery.

A randomized and double-blinded trial with parallel assignments (Canadian Task Force Classification I).

The study was conducted in the gynecologic department at the University Hospital of Stavanger, Stavanger, Norway.

Twenty-four women eligible for elective laparoscopic surgery for a benign indication within an ERP were included.

The women were randomized to preemptive local injections of either 0.5% bupivacaine (intervention group) or 0.9% saline (control group) at each trocar site.

The primary outcome measure of the study was movement-evoked pain 5 hours after surgery. The secondary outcome measures were pain at rest 2 and 5 hours after surgery and the use of rescue analgesics during the postoperative period. Pain was measured on a numeric rating scale of 0 to 10. Data were treated to a per-protocol analysis, and a p < .05 was considered significant.

Twenty-three women completed the trial. The median score for movement-evoked pain 5 hours after surgery was significantly lower in the intervention group (1 vs. 3, p = .044). There was no difference in pain at rest after 2 and 5 hours and no difference in the requirement for rescue analgesics.

Preemptive local anesthetics in the trocar areas are shown to be beneficial in laparoscopic gynecologic surgery within an enhanced recovery program. Movement-evoked pain is far more intense than pain at rest.