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LETTER TO THE EDITOR

Intraperitoneal Local Anesthesia During Laparoscopic Cholecystectomy: The Role of Meta-Analytical Subgroups and Delivery of the Local Anesthetic

Department of Biosurgery and Surgical Technology; Imperial College; St. Mary's Hospital; London, W2 1NY; United Kingdom; s.purkayastha{at}imperial.ac.uk

To the Editor:

Recently, Boddy et al. (1) described the results of a meta-analysis of randomized controlled trials (RCTs) assessing the effect of intraperitoneal (IP) local anesthetic on postoperative pain after cholecystectomy (1). Results of meta-analyses of RCTs have been shown to demonstrate different outcomes from subsequent large randomized trials up to 35% of the time (2). The authors correctly address the issues of numerous factors that may influence the benefits of IP anesthesia. However, one aspect of this analysis, not available from the included trials, was the mode of delivery of the local anesthetic.

We have developed a novel delivery system for the aerosolized delivery of local anesthesia which has been tested in the setting of a double-blind, RCT of 80 patients (3). This has demonstrated that aerosolized IP bupivacaine (10 mL of 0.5%) significantly reduced postoperative pain in comparison with all other treatments (P = 0.0004) and almost eliminated opiate consumption in the treatment group (P = 0.0002) (4). Postoperative pain control and the need for opiate administration may be regarded as the main factors behind the slow acceptance of laparoscopic cholecystectomy as a purely day–case procedure and we believe that controlling these two factors will ultimately make day– case laparoscopic cholecystectomy a routine, practical option in the United Kingdom.

Aerosolized local anesthetic is a very effective method to control postoperative pain and it may help to abolish opiate use leading to shorter hospitalization and less cost.

Footnotes

Dr. Rhodes does not wish to respond.

REFERENCES

1. Boddy AP, Mehta S, Rhodes M. The effect of intraperitoneal local anesthesia in laparoscopic cholecystectomy: a systematic review and meta-analysis. Anesth Analg 2006;103:682–8.[Abstract/Free Full Text]
2. LeLorier J, Gregoire G, Benhaddad A, et al. Discrepancies between meta-analyses and subsequent large randomized, controlled trials. N Engl J Med 1997;337: 536–42.[Abstract/Free Full Text]
3. Alkhamesi NA, Peck DH, Lomax D, Darzi AW. Aerosolized bupivacaine reduces post-laparoscopic pain: a randomized controlled double blinded clinical trial. J Pain 2006;7 (S2):P3.
4. Alkhamesi NA, Peck DH, Lomax D, Darzi AW. Intra-peritoneal aerosolization of bupivacaine reduces postoperative pain in laparoscopic surgery: a randomized prospective controlled double blinded clinical trial. Surg Endosc 2006; [Epub ahead of print].

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