Abstracts
2002 Digestive Disease Week

# 100622 Abstract ID: 100622 Postoperative Pain Relief from Intrapleural Bupivicaine Following Laparoscopic Fundoplication: A Randomised Controlled Trial
Shorland Hosking, Nicholas Johnson, Hossam Makar, Peter Thomas, Poole, UK

Background: Shoulder tip and port site pain can be troublesome following laparoscopic fundoplication (LF). Referred shoulder pain can be reduced by infiltration of local anaesthetic around the phrenic nerve (scalene block). Other studies indicate that local anaesthetic placed into the pleural cavity (intrapleural injection) diffuses across the pleura and reduces sensory transmission in intercostal nerves. HYPOTHESIS: Intrapleural bupivicaine placed perioperatively will diffuse across pleura to block phrenic and intercostal nerves, and reduce referred shoulder and abdominal wall pain post operatively. STUDY DESIGN: 122 patients undergoing LF were randomised to receive at the end of their operation either (a) intrapleural bupivicaine 15mls x 0.5% injected into each pleural cavity (total 15mg) or (b) intraperitoneal bupivicaine 100mls x 0.1% subdiaphragmatically AND 20mls x 0.25% port site infiltration (total 15mg). Intraoperative analgesia was standardised and a regimen of oral analgesia was available post operatively on demand. The patients and assessors were blinded. RESULTS: Age, gender and duration of surgery were similar in both groups. Visual analogue scores for shoulder pain and abdominal pain were similar 2, 8, 24 and 48 hours post operatively. Supplemental oral analgesia consumption was required by 61 (50%) patients in each group. Post operative discharge occurred on day 1 in 74% and 67% of intrapleural and intraperitoneal patients respectively (P=NS). Complication rates were extremely low and similar in both groups. CONCLUSION: Bilateral intrapleural bupivicaine injection is as effective in relieving post laparoscopic shoulder tip and port site pain, as subdiaphragmatic (intraperitoneal) and port site injection. The need for supplemental analgesia by 50% of patients indicates that neither regimen is ideal.