Effect of Local Anesthesia on the Postoperative Pain After Laparoscopic Appendectomy

Background: Laparoscopic surgery causes less pain than traditional surgery; however, to relieve postoperative pain, surgeons frequently apply local anesthetic preemptively. The aim of this study was to assess the effect of different local anesthetics on pain intensity in patients who had undergone a laparoscopic appendectomy (LA), who received the anesthetic preemptively at incision sites and postemptively, intraperitoneally and trocar sites. Patients and Methods: A total of 120 LA patients (men and women) were randomly assigned to 1 of the 4 groups (N=30/group): Group 1: no peritoneal or local administration of local anesthetics during LA; Group 2: 5mL of 1% lidocaine was applied at incision sites and 10mL 1% lidocaine was injected under direct vision in the right iliac fossa area and around the stump of the appendix and trocar sites at the end of the procedure; Group 3: 5mL of 0.5% levobupivacaine applied at incision sites +10mL 0.5% levobupivacaine injected in the same place intraperitoneally and trocar sites at the end of the procedure; Group 4: 5mL of 0.5% ropivacaine at incision sites +10mL 0.5% ropivacaine injected in the same place intraperitoneally and trocar sites at the end of the procedure. Postoperative pain was assessed after 2, 6, 24, and 48 hours using a visual analogue scale (VAS). Results: By comparing the average values of pain intensity using VAS, we observed significantly different average values of pain intensity in the levobupivacaine and ropivacaine (3 and 4) groups in comparison with the control Group 1 (P<.05) throughout the follow-up period. Conclusion: We observed a reduction in postoperative pain, nausea, and vomiting in patients with LA who received intraoperative local anesthetic preemptively at the incision sites and postemptively, intraperitoneally. After the application of levobupivacaine the intensity of pain was significantly lower than in any other tested group.