Rivard, C., Vogel, R.I., & Teoh, D. (2015). Effect of intraperitoneal bupivacaine on postoperative pain in the gynecologic oncology patient. Journal of Minimally Invasive Gynecology, 22, 1260–1265.

To evaluate the effect of intraperitoneal bupivacaine on postoperative pain in patients undergoing minimally invasive gynecologic surgeries

At the end of the surgical procedure, a single dose of 20 ml of 0.25% bupivacaine was given intraperitoneally. Patients receiving this intervention were compared with historical control subjects who had the same types of surgical procedures. Regimens for postoperative pain management were the same for both groups of patients, including IV fentanyl during surgery and in the postanesthesia care unit, ketorolac until discharge or 24 hours postoperatively, and transition to ibuprofen 600 mg orally every six hours. Oral oxycodone/acetaminophen and IV hydrocodone or hydromorphone was used as needed if oral medications were insufficient. Patient-reported pain scores and narcotic analgesic use were obtained on the day of surgery and for two days postoperatively.

• N = 130   
• MEAN AGE = 57.7 years 
• FEMALES: 100%
• CURRENT TREATMENT: Other
• KEY DISEASE CHARACTERISTICS: All had robotic or laparoscopic gynecological procedures, 50% of the sample had gynecologic cancer, and a higher percentage of those in the bupivacaine group had cancer.

• SITE: Single site   
• SETTING TYPE: Inpatient    
• LOCATION: Minnesota

• PHASE OF CARE: Active antitumor treatment

• Retrospective cohort comparison

• 100-point pain visual rating scale
• Medical record documentation of narcotic use (in morphine equivalents)

Median narcotic use was significantly lower in the bupivacaine group on the day of surgery (p = 0.007) and postop day 1 (p < 0.001). On postop day 2, narcotic use in the bupivacaine group was lower, but the difference was not significant. Pain score on the day of surgery was lower in the bupivacaine group (p = 0.05). Pain ratings were also lower on postop days 1 and 2, but differences were not statistically significant.

Instillation of local anesthetic into the peritoneal cavity was associated with improved postoperative pain control among women undergoing minimally invasive gynecologic procedures.

• Risk of bias (no blinding)
• Risk of bias (no random assignment)
• Findings not generalizable
• Only minimally invasive surgeries were evaluated. Though authors reported use of a 10-point pain rating scale, data reported appears to be from a 100-point scale.

This study adds to the body of evidence showing efficacy of local anesthetic instillation into the surgical site area for improvement in acute pain control. Nurses can advocate for consideration of this type of approach for acute pain management.