Effect of presurgical local infiltration of levobupivacaine in the surgical field on postsurgical wound pain in laparoscopic gynecological surgery

Background. To maintain a high standard of patient care, it is essential to provide adequate pain management in patients who undergo laparoscopic surgery. Methods. We randomly enrolled 74 women who underwent laparoscopic surgery for gynecological benign diseases. Patients in the levobupivacaine group (n = 37) were injected with 7 ml of 5 mg/ml levobupivacaine at all incisional areas patients in the control group (n=37) were injected with an equal volume of physiologic saline solution. In the postoperative period the following variables were assessed for each group: decline of hemoglobin concentration, consumption of analgesics, time of ambulation, length of postoperative ileus, length of postoperative hospital stay, and VAS scores at 6, 12, and 24 h after surgery. Results. Mean pain intensity at 6 and 12 h after surgery was significantly lower in the levobupivacaine group than in the control group (p < 0.01). Analgesic requirement was significantly lower (p < 0.01) in the levobupivacaine group (0.3 phial +/- 0.2) than in the control group (2.1 phial +/- 1.0). The mean time of ambulation was significantly lower (p < 0.05) in the levobupivacaine group (16 +/- 4) than in the control group (22 +/- 6). No significant difference was observed between the two groups in mean pain intensity 24 h after surgery, decline of hemoglobin concentration, length of postoperative ileus, or length of postoperative hospital stay. Conclusions. Our results suggest that presurgical infiltration of levobupivacaine in addition to general anesthesia and standard analgesic therapy significantly decreases the intensity of postsurgical pain, especially for the first 12 h after surgery, and reduces analgesic consumption after surgery.