Effectiveness of Intraperitoneal Bupivacaine in General Anesthesia for Laparoscopic Appendectomy

Sarah Lorenza Caverina, Fanda Ayyu Rindiati, F.X. Andhi Haris Respati

Abstract

Introduction: Appendicitis is an inflammation of vermiform appendix organ. It is a medical emergency case and one of the most common acute abdominal cases. The removal of acute appendix with minimally invasive surgery, laparoscopic procedure, is associated with shortened recovery time and length of stay in hospital, reduced risk of postoperative wound infections, also improved cosmetic outcomes. Anesthesia procedure for laparoscopic in Indonesia is usually performed under general anesthesia (GA) which has effective and safe form of sedation. One local anesthesia agent that often used in laparoscopic procedure is bupivacaine. Studies have shown that intraperitoneal bupivacaine as analgesia after laparoscopy can reduce postoperative pain, such as visceral pain associated with tissue injury and the stretching of nerve endings in the peritoneal cavity, parietal pain related to the incisional trauma at the port sites, and shoulder pain referred by stretching of the diaphragm.

Case report: Mr. TA, 27 years old, his lower right abdomen hurt and he was diagnosed with acute appendicitis ASA II. Patients performed with laparoscopic procedure under general anesthesia. Fentanyl 2 mcg/kg, propofol 2 mg/kg, rocuronium 0.6 mg/kg, and sevoflurane 1 MAC, 50% FiO2 : 50% water, 4 lpm flow were administered. After 90 minutes of surgery, 40 cc of 0.5% intraperitoneal bupivacaine was administered. Patient was assessed for the NRS score within 30 minutes after laparoscopic procedure. The NRS score was 0.

Conclusion: It has been reported a patient underwent laparoscopic appendicitis procedure received intraperitoneal bupivacaine as a postoperative analgesia which provided quicker recovery and good improvement of pain control without any significant negative consequences.

Keywords

Appendicitis; Laparoscopy; General anaesthesia (GA); Intraperitoneal Bupivacaine; Pain

Full Text:

PDF

References

  1. Review, C. (2021). Diagnosis and Management of Acute Appendicitis in Adults A Review. 326(22). https://doi.org/10.1001/jama.2021.20502
  2. Krzyzak M, Mulrooney SM. Acute Appendicitis Review: Background, Epidemiology, Diagnosis, and Treatment. Cureus. Juni 2020;12(6):e8562.
  3. Jaschinski T, Mosch CG, Eikermann M, Neugebauer EAM, Sauerland S. Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev. 2018;(11).
  4. Jo, Youn & Kwak, Hyun-Jeong. (2017). What is the proper ventilation strategy during laparoscopic surgery?. Korean Journal of Anesthesiology. 70.596. 10.4097/kjae.2017.70.6.596.
  5. Eva, I., Rosario, V., Guglielmo, R., Clarissa, V., Presti, L., Emma, C., Rossella, C., & Veronica, V. (2022). Laparoscopic surgery : A randomised controlled trial comparing intraoperative hemodynamic parameters and arterial-blood gas changes at two different pneumoperitoneal pressure values. Annals of Medicine and Surgery, 81(August), 104562. https://doi.org/10.1016/j.amsu.2022.104562
  6. Townsend, C. M., Beauchamp, R. D., Evers, B. M., & Mattox, K. L. The appendix. Dalam: Sabiston textbook of surgery: The biological basis of modern surgical practic (20th edition.). Philadelphia, PA: Elsevier; 2018, p 1296-1297.
  7. Sembiring (2018) Prevalensi Peritonitis pada Pasien Apendisitis di RSUP Haji Adam Malik periode 2017-2018.
  8. Fenwick, A.K., Hartery, A. Appendicitis and beyond: a pictorial review of various appendiceal abnormalities. Emerg Radiol 28, 651–664 (2021). https://doi.org/10.1007/s10140-021-01908-3
  9. Snyder MJ, Guthrie M, Cagle S. Acute Appendicitis: Efficient Diagnosis and Management. Am Fam Physician. 2018;98(1):25-33.
  10. Ha H-K, Lee K-G, Choi KK, Kim WS, Cho HR. Effect of bupivacaine on postoperative pain and analgesics use after single-incision laparoscopic appendectomy: double-blind randomized study. Ann Surg Treat Res. Februari 2020;98(2):96–101
  11. Hori, T., Machimoto, T., Kadokawa, Y., Hata, T., Ito, T., & Kato, S. (2017). Laparoscopic appendectomy for acute appendicitis : How to discourage surgeons using inadequate therapy. 23(32), 5849–5859. https://doi.org/10.3748/wjg.v23.i32.5849
  12. Abmm, A., Deeba, F., Khatun, S., Sa, A., & Mm, R. (2019). Original Article Combined Use of Intraperitoneal and Incisional Bupivacaine Reduces Pain Severity after Diagnostic Laparoscopic in Infertile Women.
  13. Nikoubakht, N., Hamid, S., Faiz, R., Mousavie, S. H., & Shafeinia, A. (2022). Effect of bupivacaine intraperitoneal and intra ‑ abdominal bicarbonate in reducing postoperative pain in laparoscopic cholecystectomy : a double ‑ blind randomized clinical trial study. BMC Research Notes, 1–6. https://doi.org/10.1186/s13104-022-06083-3
  14. Wang, D., Dong, T., Shao, Y., Gu, T., Xu, Y., & Jiang, Y. (2019). Laparoscopy versus open appendectomy for elderly patients , a meta-analysis and systematic review. 1–11
  15. Mucilli, F., Barone, M., Capone, S., Peccianti, M. M., Guetti, L., Prioletta, M., Atti, I. D., & Maggiore, S. M. (2020). Laparoscopic appendectomy in adult patients : locoregional or general anesthesia ? A meta-analysis. 3. https://doi.org/10.21037/ls.2020.03.02
  16. Barash PG, Cullen BF, Steolting RK, et al. Handbook of Clinical Anesthesia. Philadelphia: Lippincott Williams & Wilkins; 2017.
  17. Jha N, Jha AK. Intraperitoneal Instillation of Local Anesthetics: Is This a Suitable Alternative for Postcesarean Pain Relief Without Toxicity Profiling? Anesth Analg [Internet]. 2017;125(1). Tersedia pada: https://journals.lww.com/anesthesia-analgesia/Fulltext/2017/07000/Intraperitoneal_Instillation_of_Local_Anesthetics_.56.aspx
  18. Gupta, R. S., Rai, A., Vasuniya, V., & Choudhary, D. (2018). Comparative evaluation of subcutaneous infiltration ( port site ) vs intraperitoneal infiltration of bupivacaine on post laparoscopic cholecystectomy pain. 5(2), 500–506.

Refbacks

  • There are currently no refbacks.