• Jon I Einarsson, Judy Sun, John Orav, and Amy E Young.
• Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA. jonival@yahoo.com
• Obstet Gynecol. 2004 Dec 1;104(6):1335-9.

ObjectiveTo investigate whether local infiltration of bupivacaine reduces postoperative pain at trocar sites during gynecologic laparoscopy.MethodsThis was a randomized, placebo-controlled, double-blind clinical trial, using patients as their own controls. For each patient, 2 opposite trocar sites were infiltrated. One site was randomly chosen to receive 0.5% bupivacaine, and the other received 0.9% saline. In addition, patients were randomized into 2 cohorts to receive either preincision or postsurgical infiltration. Surgeons, patients, and interviewers were blinded toward the exposure. Postoperative pain was evaluated at 1 hour, 4 hours, and 24 hours after surgery using a 100-mm visual analog scale. Patients rated their pain at each of the infiltrated trocar sites. A 20-mm difference between pain scores was considered clinically significant. A paired t test was used for analysis.ResultsInfiltration of bupivacaine at completion of surgery resulted in significantly decreased pain at 1 hour postoperatively (mean pain score 25.8 versus 48.6, P = .02). Mean pain scores at 4 hours and 24 hours were decreased, but not statistically different. Patients receiving bupivacaine before surgery did not have a statistically significant decrease in pain scores.ConclusionInfiltration of bupivacaine at completion of gynecologic laparoscopic surgery decreases pain at trocar sites in the immediate postoperative period.

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