• Arman Kahokehr, Tarik Sammour, Mattias Soop, and Andrew G Hill.
• Department of Surgery, University of Auckland, South Auckland Clinical School, Middlemore Hospital, New Zealand. arman.kahokehr@middlemore.co.nz
• ANZ J Surg. 2011 Apr 1;81(4):237-45.

BackgroundThe use of intraperitoneal local anaesthetic (IPLA) can be used to modulate visceral nociception after abdominal surgery; however, this technique is not routinely used in open abdominal surgery. The aim of this systematic review was to appraise the clinical effects of IPLA in open abdominal surgery for metachronous outcomes including pain, metabolic response to surgery and gastrointestinal function.MethodsA comprehensive search was conducted independently without language restriction. Relevant meeting abstracts and reference lists were manually searched. Data analysis was performed using Review Manager Version 5.0 software. Post-operative clinical and metabolic outcomes of randomized controlled trials comparing IPLA versus no IPLA or placebo solution were used for meta-analysis.ResultsTwelve trials were identified including eight randomized trials in gastrointestinal and gynaecological surgery. Post-operative pain was reduced but not opioid use. There was blunting of postoperative hyperglycaemia. There was no difference in post-operative cortisol response. Return of bowel function appeared to be quickened, although meta-analysis was not possible.ConclusionThe use of IPLA is safe and appears to have clinical benefits. However this technique has not been studied in optimized perioperative settings. Trials are needed to evaluate this method of visceral blockade further after major abdominal surgery.© 2010 The Authors. ANZ Journal of Surgery © 2010 Royal Australasian College of Surgeons.

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