Effect of local anesthetics on postoperative pain in patients undergoing gynecological laparoscopy: A systematic review and meta-analysis of randomized trials

Martin Hirsch, Laiba Tariq, James Mn Duffy
Journal of Minimally Invasive Gynecology 2021 May 12

OBJECTIVE: Pain remains a common complication following gynecological laparoscopy. Use of local anesthesia may be beneficial in reducing postoperative pain. We performed a systematic review and meta-analysis to assess whether local anesthetic decreases postoperative pain following laparoscopic gynecological procedures.

DATA SOURCES: We searched Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, and Medline from inception to November 2020 using MeSH and free text combinations.

METHODS OF TRIAL SELECTION: We included randomized controlled trials of patients undergoing gynecological laparoscopy receiving port-site subcutaneous; subfascial; or intra-peritoneal local anesthetic compared to placebo, or no intervention. We included 20 trials (1861 participants) with size varying between 28 to 164 participants.

TABULATIONS, INTEGRATION, AND RESULTS: Meta-analysis was performed with RevMan 5.3 (Cochrane Collaboration, London, United Kingdom), with standard mean differences (SMD) and random-effects model. Port-site infiltration reduces postoperative pain at 4 hours (SMD -0.25, 95% CI -0.44 to -0.06; 4 trials, 545 participants) and 6 hours (SMD -0.44; 95% CI -0.82 to -0.06; 4 trials, 455 participants). The administration of intraperitoneal local anesthetics reduces pain at 6 hours [-1.42; 95% CI -3.22, -0.30; 4 trials, 277 participants).

CONCLUSIONS: The use of port-site and intraperitoneal local anesthetic decreases immediate postoperative pain in patients undergoing gynecological laparoscopy although its impact on analgesia requirements is unclear. Routine usage of local anesthetics should be considered for people undergoing gynecological laparoscopy.

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