Analgesic Effects of Intraperitoneal Bupivacaine Following Laparoscopic Bariatric Surgery: A Randomized Clinical Trial

Background Postoperative pain is a significant concern following laparoscopic bariatric surgery. Effective analgesia is essential to facilitate recovery, reduce complications, and minimize opioid consumption, especially in patients with obesity who are more susceptible to respiratory compromise. This randomized clinical trial aimed to evaluate the efficacy of weight-standardized intraperitoneal instillation of local anesthetic (IPILA) using 0.2% bupivacaine in reducing postoperative pain among patients undergoing laparoscopic bariatric procedures. Methods Ninety adult patients undergoing bariatric surgery were randomly assigned to either an intervention group receiving intraperitoneal bupivacaine (0.5 mL/kg) or a control group receiving no instillation. Pain scores were measured using the Visual Analogue Scale (VAS) at recovery, and 2, 4, and 24 h postoperatively. Secondary outcomes included analgesic and antiemetic use after surgery. Results The intervention group showed significantly lower VAS scores at recovery (2.2 ± 0.6 vs. 4.5 ± 1.2) and at 2 h (2.7 ± 1.2 vs. 4.1 ± 1.1) compared to the control group ( p < 0.001). No significant difference was observed at 4 and 24 h. Analgesic and antiemetic requirements were similar between groups. Conclusion Intraperitoneal instillation of bupivacaine significantly reduces early postoperative pain after bariatric surgery without increasing complications or analgesic needs. While its effect does not extend beyond the immediate postoperative period, IPILA remains a simple, safe, and effective adjunct to multimodal analgesia protocols in bariatric patients for early postoperative pain control.