Intraoperative Injection of Bupivacaine to the Diaphragmatic Crura Significantly Eliminates the Need for Opioids After Laparoscopic Nissens Fundoplication

Objective: Our purpose was to compare the efficacy of crural injection of Bupivacaine on perioperative analgesic requirements in patients undergoing laparoscopic nissens fundoplication.

Methods: We performed a double blind prospective randomized cohort study to minimize experimenter expectancy on the results. 50 patients planned for laparoscopic nissens fundopilcation were chosen and assigned in to two groups of 25, randomly, between February 2007-March 2009. Each patient in the study group received two 1 cc injections of Bupivacaine in each crura before suturing while the control group was administered 0.9% Saline, all patients received tenoxicam 20 mg IV prior to extubation. Peri-operative pain management was determined by patient centered discussions, VAS scores were recorded and opioids were administered as needed.

Results: All patients undergoing abdominal operations under general anesthesia were admitted to the post-operative care unit for 24 hours as required by our institutional policy. VAS scores in the study group vere significantly lower compared to the control group P<0.05 (2.5 vs 3.8). There was no difference in NSAID administration, 23/25 patients in the control group needed an other doseof Tenoxicam 20 mg IV in the next 24 hours versus 20/25 patients in the study group (p>0.05). Opioid requirements were higher in the control group, 17/25 patients in the control group needed Petidine 50 mg IV for adequate analgesia versus 5/25 patients in the study group(p<0.05).

Conclusion: Our series are of relatively limited number and our results need to be verified by larger series. In our double blinded study, pain control was easily achieved by NASIDs in the study group. The need for opioids were significantly higher in the control group as well as the VAS scores. We have found crural Bupivacaine injection to be an effective treatment for the management of perioperative pain in patients undergoing Laparoscopic Nissens Fundoplication.

Session: Podium Presentation

Program Number: S080