Intra-peritoneal bupivacaine alone or in combination with morphine in patients undergoing vertical bypass gastroplasty

Background and knowledge: Intra-peritoneal instillation of local anesthesia and morphine has been used to alleviate post-operative pain in laparoscopic surgery. Controversy exists about the efficacy of this technique. Methods: We studied 48 patients scheduled for Vertical Bypass Gastroplasy (VBG). All of them received the same technique of general anesthesia (GA). Patients were randomly allocated into four equal groups. They received equal volumes of the test drug instilled in the peritoneal cavity at the end of laparoscopy, 50 ml of normal saline (Group S): 50 ml of bupivacaine 0.25% (Group B), 50 ml of bupivacaine 0.25%, plus morphine 40 mcg.kg-1 (maximum of 5 rug) Group M or (Group D) patients received the same regimen as Group M in addition, they received 75 mg intra-muscular diclophenac after induction of general anesthesia. Wound edges were infiltrated with 10 ml bupivacaine 0.25% in all patients. Morphine 25-50 mcg.kg-1 was given intravenously every 10 mm as a rescue analgesic to control postoperative pain in Post Anesthesia Care Unit (PACU). Post operative pain was evaluated using Visual Analogue Scale (VAS). vital signs and morphine consumption, and time to receive rescue analgesia were measured at different intervals. The incidence of postoperative complications (respiratory depression. oxygen de-saturation. arid nausea and vomiting) was recorded as well as hospital stay. Results: There was significant decrease in VAS, HR. MBP and morphine consumption in Groups M & D when compared to Groups S & B on admission and on discharge from PACU. There were significant decrease in time to receive rescue analgesia as well as significant reduction in hospital study in Groups M and D when compared to Groups S and B. However, there was no significant difference between group S & B regarding the same parameters. Conclusions: The presented technique is safe and easy to use with good postoperative morphine sparing analgesia, excellent patient satisfaction and short hospital stay.