Meta-Analysis
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 21, 2015; 21(47): 13386-13395
Published online Dec 21, 2015. doi: 10.3748/wjg.v21.i47.13386
Effect of intraperitoneal local anesthetic on pain characteristics after laparoscopic cholecystectomy
Geun Joo Choi, Hyun Kang, Chong Wha Baek, Yong Hun Jung, Dong Rim Kim
Geun Joo Choi, Hyun Kang, Chong Wha Baek, Yong Hun Jung, Dong Rim Kim, Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine, Seoul 06911, South Korea
Author contributions: Choi GJ designed the study, conducted the study (selected study, extracted data), analysed and interpreted the data, wrote the manuscript; Kang H designed the study, conducted the study (extracted data), analysed and interpreted the data, wrote the manuscript; Baek CW conducted the study (helped to select study, assessed the risk of bias), provided critical revision of the manuscript; Jung YH conducted the study (helped to select study, assessed the risk of bias), provided critical revision of the manuscript; Kim DR conducted the study (selected study), analysed the data and wrote the manuscript; all authors approved the final manuscript.
Conflict-of-interest statement: The authors deny any conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hyun Kang, MD, PhD, MPH, Associate Professor, Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine, 84 Heukseok-ro, Dongjak-gu, Seoul 06911, South Korea. roman00@naver.com
Telephone: +82-2-62992583 Fax: +82-2-62992585
Received: April 28, 2015
Peer-review started: May 6, 2015
First decision: August 31, 2015
Revised: September 14, 2015
Accepted: October 12, 2015
Article in press: October 13, 2015
Published online: December 21, 2015
Processing time: 230 Days and 15.1 Hours
Abstract

AIM: To systematically evaluate the effect of intraperitoneal local anesthetic on pain characteristics after laparoscopic cholecystectomy (LC).

METHODS: We searched MEDLINE, EMBASE, and the Cochrane Library. Randomized controlled trials in English that compared the effect of intraperitoneal administration of local anesthetics on pain with that of placebo or nothing after elective LC under general anesthesia were included. The primary outcome variables analyzed were the combined scores of abdominal, visceral, parietal, and shoulder pain after LC at multiple time points. We also extracted pain scores at resting and dynamic states.

RESULTS: We included 39 studies of 3045 patients in total. The administration of intraperitoneal local anesthetic reduced pain intensity in a resting state after laparoscopic cholecystectomy: abdominal [standardized mean difference (SMD) = -0.741; 95%CI: -1.001 to -0.48, P < 0.001]; visceral (SMD = -0.249; 95%CI: -0.493 to -0.006, P = 0.774); and shoulder (SMD = -0.273; 95%CI: -0.464 to -0.082, P = 0.097). Application of intraperitoneal local anesthetic significantly reduced the incidence of shoulder pain (RR = 0.437; 95%CI: 0.299 to 0.639, P < 0.001). There was no favorable effect on resting parietal or dynamic abdominal pain.

CONCLUSION: Intraperitoneal local anesthetic as an analgesic adjuvant in patients undergoing laparoscopic cholecystectomy exhibited beneficial effects on postoperative abdominal, visceral, and shoulder pain in a resting state.

Keywords: Local anesthetic; Laparoscopic cholecystectomy; Intraperitoneal; Meta-analysis; Pain

Core tip: Pain after laparoscopic cholecystectomy is located at abdomen or shoulder, and abdominal pain includes visceral and parietal pain. This characteristic pain is mainly because of pneumoperitoneum, which leads to visceral and shoulder pain. Intraperitoneal local anesthetics thus can be a beneficial strategy given the origin of various type of pain after laparoscopic cholecystectomy, which is evaluated systematically focused on the analgesic efficacy on pain characteristics. Intraperitoneal local anesthetics in patients undergoing laparoscopic cholecystectomy has the evidence to reduce postoperative abdominal, visceral, and shoulder pain. Further less heterogeneous evidence is necessary to draw definite conclusion.