Effect of Local Anesthetic Infiltration for Postoperative Pain Control in Laparoscopic Abdominal Surgery: A Prospective Randomized Study
试验速览
- 阶段
- 不适用
- 状态
- 尚未招募
- 发起方
- 入组人数
- 166
- 试验地点
- 1
- 主要终点
- Postoperative Pain Intensity
研究概览
简要总结
Brief Summary
Postoperative pain remains a common problem after laparoscopic abdominal surgery despite the minimally invasive nature of these procedures. Pain mainly arises from the trocar insertion sites, tissue manipulation, and the effects of pneumoperitoneum. Although systemic analgesics are routinely used, they may not provide adequate pain relief and can be associated with adverse effects.
This prospective randomized controlled trial aims to evaluate whether pre-incisional infiltration of bupivacaine at laparoscopic trocar insertion sites reduces postoperative pain compared with standard care without local anesthetic infiltration. A total of 166 adult patients undergoing elective laparoscopic abdominal surgery will be randomly assigned to receive either local bupivacaine infiltration before skin incision or no local anesthetic infiltration. All participants will receive the same standard perioperative care and postoperative analgesic regimen.
The primary outcome is postoperative pain intensity measured using the Visual Analog Scale (VAS) during the first 24 hours after surgery. Secondary outcomes include the time to first rescue analgesic, total opioid consumption within the first 24 hours, and overall postoperative pain control. The results of this study may help determine whether local bupivacaine infiltration is an effective, simple, and low-cost addition to multimodal analgesia for patients undergoing laparoscopic abdominal surgery.
详细描述
Detailed Description
Laparoscopic abdominal surgery is widely performed because it is associated with reduced surgical trauma, shorter hospital stays, and faster recovery compared with open procedures. Despite these advantages, postoperative pain remains a significant concern. Pain after laparoscopy is multifactorial, resulting from trocar insertion, tissue manipulation, and pneumoperitoneum. Although multimodal analgesia is routinely employed, optimal management of trocar-site pain remains uncertain.
Local infiltration of surgical incision sites with long-acting local anesthetics such as bupivacaine has been proposed as a simple and inexpensive method of reducing postoperative pain and opioid requirements. However, published randomized trials have reported inconsistent findings regarding the magnitude of benefit, and variations in infiltration technique, timing, and dosage have limited the establishment of standardized recommendations. Additional prospective randomized studies are needed to evaluate the effectiveness of this intervention in different clinical settings.
This single-center prospective randomized controlled trial will be conducted in the Department of General Surgery, Allied Hospital, Faisalabad. Adult patients undergoing elective laparoscopic abdominal surgery will be randomly allocated in a 1:1 ratio to receive either pre-incisional infiltration of diluted bupivacaine at planned trocar insertion sites or no local anesthetic infiltration. All participants will receive the institution's standard perioperative management and postoperative analgesic protocol.
The study aims to determine whether pre-incisional local bupivacaine infiltration provides superior postoperative pain control during the first 24 hours after laparoscopic abdominal surgery. Pain intensity will be assessed using the Visual Analog Scale (VAS), while opioid consumption and time to first rescue analgesia will be evaluated as secondary measures of analgesic efficacy. The findings may help clarify the role of local anesthetic infiltration as part of multimodal postoperative pain management and contribute evidence to guide clinical practice in patients undergoing laparoscopic abdominal surgery.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 60 Years（Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Adults aged 18 to 60 years. Scheduled for elective laparoscopic abdominal surgery (e.g., cholecystectomy, appendectomy, or hernia repair).
- •American Society of Anesthesiologists (ASA) physical status I or II. Able to understand and use the Visual Analog Scale (VAS) for pain assessment. Willing and able to provide written informed consent.
排除标准
- •Intraoperative conversion to open laparotomy. Known allergy, hypersensitivity, or contraindication to bupivacaine or other amide local anesthetics.
- •Pregnancy or breastfeeding. History of chronic pain syndromes or regular use of opioid or non-opioid analgesics before surgery.
- •History of substance abuse or severe psychiatric disorders that may affect pain perception.
- •Local skin infection at the planned trocar insertion sites.
研究组 & 干预措施
Bupivacaine Infiltration Plus Standard Care
Participants undergoing elective laparoscopic abdominal surgery will receive pre-incisional infiltration of 20 mL of 0.5% bupivacaine diluted with 20 mL of normal saline (final concentration 0.25%). The solution will be equally infiltrated into the planned trocar insertion sites before skin incision in addition to standard perioperative care.
干预措施: Standard Perioperative Analgesia (Other)
Standard Care
Participants undergoing elective laparoscopic abdominal surgery will receive standard perioperative care and postoperative analgesia without local bupivacaine infiltration at the trocar insertion sites.
干预措施: Standard Perioperative Analgesia (Other)
Bupivacaine Infiltration Plus Standard Care
Participants undergoing elective laparoscopic abdominal surgery will receive pre-incisional infiltration of 20 mL of 0.5% bupivacaine diluted with 20 mL of normal saline (final concentration 0.25%). The solution will be equally infiltrated into the planned trocar insertion sites before skin incision in addition to standard perioperative care.
干预措施: Bupivacaine (Drug)
结局指标
主要结局
Postoperative Pain Intensity
时间窗: At 1, 6, 12, and 24 hours after surgery
Postoperative pain intensity measured using the Visual Analog Scale (VAS; 0-10), comparing the experimental and control groups during the first 24 hours after laparoscopic abdominal surgery.
次要结局
- Time to First Rescue Analgesia(Within 24 hours after surgery)
- Total Opioid Consumption(Within 24 hours after surgery)
研究者
Jawad Qamar
Postgraduate resident
Allied Hospital Faisalabad