Intraperitoneal Local Anesthetic Instillation for Post-Operative Pain Control After Bariatric Surgery: A Systematic...

Area of Science:

• Anesthesiology
• Surgical Innovation
• Pain Management

Background:

• Postoperative pain is a significant challenge after bariatric surgery, affecting over 60% of patients.
• Intraperitoneal local anesthetic instillation (IPLA) is a potential strategy to mitigate pain and reduce opioid use.
• The efficacy of IPLA in bariatric surgery remains debated, necessitating further investigation.

Purpose of the Study:

• To systematically evaluate the effectiveness of intraperitoneal local anesthetic instillation (IPLA) in managing postoperative pain following bariatric surgery.
• To assess the impact of IPLA on opioid consumption and adverse events, including nausea and vomiting.
• To clarify the role of IPLA in the context of bariatric procedures through a meta-analysis of randomized controlled trials.

Main Methods:

• A systematic review and meta-analysis adhering to PRISMA guidelines, registered with PROSPERO.
• Comprehensive literature search across major databases (PubMed, Embase, Cochrane, Web of Science) for relevant randomized controlled trials (RCTs).
• Inclusion of 13 RCTs with 1205 participants comparing IPLA with control groups, assessing pain intensity, rescue analgesia, opioid consumption, and postoperative nausea and vomiting (PONV).

Main Results:

• IPLA significantly reduced postoperative pain intensity (SMD: -0.96) and the need for rescue analgesia (RR: 0.52).
• No significant differences were observed in postoperative opioid consumption (SMD: -0.56), PONV, or shoulder pain.
• High heterogeneity was noted across most analyses, potentially limiting the clinical applicability of the findings.

Conclusions:

• Intraperitoneal local anesthetic instillation (IPLA) demonstrates efficacy in reducing postoperative pain after bariatric surgery.
• IPLA does not appear to decrease opioid consumption or the incidence of adverse events such as PONV.
• The clinical utility of IPLA is limited by high heterogeneity; standardized trials are needed to confirm findings.