Intraperitoneal analgesia to reduce pain after laparoscopic hysterectomy: Randomized Controlled Trial

Background: Laparoscopic hysterectomy patients report high levels of postoperative pain and inadequate pain relief. This minimally invasive procedure is difficult to manage and leads to increased opioid use, limited mobility, and higher risks of complications, delayed rehabilitation and prolonged hospital stay. Objective: To determine the analgesic efficacy of bupivacaine’s intraperitoneal instillation (IP) with dexmedetomidine as an adjuvant for postoperative pain management in laparoscopic hysterectomy. Methods: This study is a randomized control clinical trial done at the Obstetrics and Gynecology Department, Ain Shams University Hospital, within 11 months (from September 2021 to August 2022). This study’s target population was all patients enrolled in laparoscopic hysterectomy. A total of 30 patients participated in this study, and we randomly divided it into two groups equally (15 patients per group). Results: There was no significant difference between groups regarding body mass index, age, parity, obstetric history, medical history, surgical history, indication of hysterectomy, type of hysterectomy, duration of surgery, and uterus size. Visual analog scores for patients at 1-, 6-, 12-, and 24-hours post-operatively increased significantly in Group B than in Group A. Furthermore, the time required for first rescue analgesia increased significantly more in Group A than in Group B. Group A required substantially less analgesic amount than Group B. Group A had significantly shorter hospital stays than Group B. There was no statistically significant difference between groups A and B in terms of adverse effects like nausea and vomiting (p>0.05) although they were less frequent in group A. Conclusion: Intraperitoneal instillation of bupivacaine combined with dexmedetomidine during laparoscopic hysterectomy substantially reduces postoperative pain and the requirement for analgesics in the postoperative period, compared to the control group, with no adverse side effects.