- Email: [email protected]
Effect of Bupivicaine on Laparoscopic Incisional Pain: A Double-Blinded, Placebo-Controlled Randomized Study
Abstracts / Journal of Minimally Invasive Gynecology 17 (2010) S90–S108 cut surface of cervix was sutured with vicry 1 continuosly. Endocervix and exocervicx were coagulated with RF. Measurements and Main Results: All patients were followed 1, 3, 6 months later op. pt age: A; 37.48(SD5.21), B; 47.35(SD7.57), pt parity: A; 0.87(SD0.71), B; 2.83(SD0.62), indication of operation Dysmenorrhea: A; 97(30%), B; 27(10%), menorrhagia: A; 49(15%), B; 81(30%), after combined: A; 146(45%), B; 148(55%), others: A; 33 (17%), B; 14(5%), op time: A; 58.03(SD12.13), B; 75(SD16.50), blood loss: A; 155.38(SD58.02), B; 280.24(SD30.11), bladder or ureteral injury: A; 5, B; 3, satisfied relief of pain: A; 205/243(85%), B; 156/175(90%), disappear of menorrhagia: A ; 179/195(92%), B; 229/229 (100%). Conclusion: Laparoscopic resection and myolysis of symptomatic adenomyoma patients who want to preserve the uterus is beneficial and safe method comparing to laparoscopically supracervical hysterectomy.
311
S93
Design: A prospective observational study. Setting: University teaching hospital. Patients: Fifty patients with symptomatic subserosal or superficial intramural myoma (%8 cm). Intervention: Single-port laparoscopic myomectomy (SP-LM) using transumbilical GelPort access.
Open Communications 19dLaparoscopy (3:44 PM d 3:49 PM)
Effect of Bupivicaine on Laparoscopic Incisional Pain: A DoubleBlinded, Placebo-Controlled Randomized Study LaMonica R, Sugarman S, Luciano DE, Luciano AA. OB/GYN-Fertility, Center for Fertility and Women’s Health, New Britain, Connecticut Study Objective: Potential benefits of preemptive analgesia have been shown in animal studies but not in humans. In this study, we evaluated post-operative incisional pain in patients who received 0.5% bupivicaine or normal saline before making the laparoscopic incision or at the end of surgery at closure. Design: Double-blinded, placebo-controlled randomized trial, IRB approved. Setting: University-affiliated teaching hospital. Patients: Women of reproductive age. Intervention: One hundred-one women of reproductive age were randomized to receive 5 ml of either bupivicaine 0.5% or normal saline subcutaneously before the skin incision at each laparoscopic puncture site or at the end of surgery at closure. Patients were asked to rate their incisional pain using a visual analogue scale numbered from 0-10 postoperatively; at 30 minutes, 2 hours and 24 hours after surgery. Measurements and Main Results: Mean pain scores were significantly higher (p\0.05) for the control groups than the bupivicaine groups, whether they were treated before or at the time of closure, but only at 30 minutes after surgery. At 2 hours and at 24 hours there was no difference in pain scores among the 4 groups. At the 2 hour mark, there was a trend toward lower pain scores for the time of closure versus the preemptive bupivicaine group but it did not reach statistical significance. No difference in consumption of pain tablets was seen during the 24 hours after surgery among the four groups. Conclusion: Subcutaneous 0.5% bupivicaine, whether administered before the incision or at the time of closure is associated with significantly less postoperative incisional pain than placebo. At the 2 hour mark, there is a trend toward lower pain scores with administration of bupivicaine at time of closure. Preemptive analgesia is not superior; in fact there may be a benefit to administering the analgesia at the time of closure when it may provide longer incisional pain relief after laparoscopic surgery.
312
Open Communications 19dLaparoscopy (3:50 PM d 3:55 PM)
Single-Port Laparoscopic Myomectomy Using Transumbilical GelPort Access Lee JH, Choi JS, Son CE, Jeon SW, Hong JH, Bae JW. Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea Study Objective: To describe our initial experience with single-port laparoscopic myomectomy (SP-LM) using transumbilical GelPort access and the surgical technique used, and to evaluate the safety and feasibility of this procedure.
Measurements and Main Results: The mean age and body mass index were 35.0 8.6 years and 22.6 2.6 kg/m2. Two patients had a history of previous abdominal surgery, consisting of one and two Cesarean deliveries. The mean operating time, hemoglobin change, return of bowel activity, and length of hospital stay were 81 21.5 minutes, 1.1 0.5 g/dL, 34.3 5.9 hours, and 3.1 0.5 days, respectively. In one patient (6.7%), SP-LM was converted to two-port LM. There were no surgical or wound complications in any patient, and the histopathological result was leiomyoma in all cases. Clinical characteristics and operative results Characteristics
Median (range)/Number (%)
Number of patients Age (years) Parity Body mass index (kg/m2) Number of previous abdominal surgery Total number of removed myomas Size of myomas (cm) Location of myomas Anterior Posterior Fundal Lateral Type of myomas Subserosal Superficial intramural Operating time (minutes) Hemoglobin change (g/dL) Return of bowel activity (hours) Hospital stay (days) Conversion rate to two-port access
15 35.0 0.6 22.6 0.6 18 5.5
8.6 0.9 2.6 0.8
1.5
8 6 2 2 8 10 81 21.5 1.1 0.5 34.3 5.9 3.1 0.5 1 (6.7)
Data are presented as mean SD Conclusion: SP-LM is feasible in selected patients with symptomatic myoma, to maximize the cosmetic benefits and to minimize woundrelated morbidity. However, the development of especially designed advanced laparoscopic instruments and increased research regarding patient selection based on objective evidence are required if we are to perform SP-LM regularly in the future.
311
S93
Design: A prospective observational study. Setting: University teaching hospital. Patients: Fifty patients with symptomatic subserosal or superficial intramural myoma (%8 cm). Intervention: Single-port laparoscopic myomectomy (SP-LM) using transumbilical GelPort access.
Open Communications 19dLaparoscopy (3:44 PM d 3:49 PM)
Effect of Bupivicaine on Laparoscopic Incisional Pain: A DoubleBlinded, Placebo-Controlled Randomized Study LaMonica R, Sugarman S, Luciano DE, Luciano AA. OB/GYN-Fertility, Center for Fertility and Women’s Health, New Britain, Connecticut Study Objective: Potential benefits of preemptive analgesia have been shown in animal studies but not in humans. In this study, we evaluated post-operative incisional pain in patients who received 0.5% bupivicaine or normal saline before making the laparoscopic incision or at the end of surgery at closure. Design: Double-blinded, placebo-controlled randomized trial, IRB approved. Setting: University-affiliated teaching hospital. Patients: Women of reproductive age. Intervention: One hundred-one women of reproductive age were randomized to receive 5 ml of either bupivicaine 0.5% or normal saline subcutaneously before the skin incision at each laparoscopic puncture site or at the end of surgery at closure. Patients were asked to rate their incisional pain using a visual analogue scale numbered from 0-10 postoperatively; at 30 minutes, 2 hours and 24 hours after surgery. Measurements and Main Results: Mean pain scores were significantly higher (p\0.05) for the control groups than the bupivicaine groups, whether they were treated before or at the time of closure, but only at 30 minutes after surgery. At 2 hours and at 24 hours there was no difference in pain scores among the 4 groups. At the 2 hour mark, there was a trend toward lower pain scores for the time of closure versus the preemptive bupivicaine group but it did not reach statistical significance. No difference in consumption of pain tablets was seen during the 24 hours after surgery among the four groups. Conclusion: Subcutaneous 0.5% bupivicaine, whether administered before the incision or at the time of closure is associated with significantly less postoperative incisional pain than placebo. At the 2 hour mark, there is a trend toward lower pain scores with administration of bupivicaine at time of closure. Preemptive analgesia is not superior; in fact there may be a benefit to administering the analgesia at the time of closure when it may provide longer incisional pain relief after laparoscopic surgery.
312
Open Communications 19dLaparoscopy (3:50 PM d 3:55 PM)
Single-Port Laparoscopic Myomectomy Using Transumbilical GelPort Access Lee JH, Choi JS, Son CE, Jeon SW, Hong JH, Bae JW. Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea Study Objective: To describe our initial experience with single-port laparoscopic myomectomy (SP-LM) using transumbilical GelPort access and the surgical technique used, and to evaluate the safety and feasibility of this procedure.
Measurements and Main Results: The mean age and body mass index were 35.0 8.6 years and 22.6 2.6 kg/m2. Two patients had a history of previous abdominal surgery, consisting of one and two Cesarean deliveries. The mean operating time, hemoglobin change, return of bowel activity, and length of hospital stay were 81 21.5 minutes, 1.1 0.5 g/dL, 34.3 5.9 hours, and 3.1 0.5 days, respectively. In one patient (6.7%), SP-LM was converted to two-port LM. There were no surgical or wound complications in any patient, and the histopathological result was leiomyoma in all cases. Clinical characteristics and operative results Characteristics
Median (range)/Number (%)
Number of patients Age (years) Parity Body mass index (kg/m2) Number of previous abdominal surgery Total number of removed myomas Size of myomas (cm) Location of myomas Anterior Posterior Fundal Lateral Type of myomas Subserosal Superficial intramural Operating time (minutes) Hemoglobin change (g/dL) Return of bowel activity (hours) Hospital stay (days) Conversion rate to two-port access
15 35.0 0.6 22.6 0.6 18 5.5
8.6 0.9 2.6 0.8
1.5
8 6 2 2 8 10 81 21.5 1.1 0.5 34.3 5.9 3.1 0.5 1 (6.7)
Data are presented as mean SD Conclusion: SP-LM is feasible in selected patients with symptomatic myoma, to maximize the cosmetic benefits and to minimize woundrelated morbidity. However, the development of especially designed advanced laparoscopic instruments and increased research regarding patient selection based on objective evidence are required if we are to perform SP-LM regularly in the future.