A Systematic Review and Meta-Analysis of Intraperitoneal Bupivacaine in Laparoscopic Gynecologic Surgery

Greg Marchand,1 Kelly Ware,1,2 Malini Govindan,1 Ahmed T Masoud,1,3 Alexa King,1,2 Stacy Ruther,1 Giovanna Brazil,1 Kaitlynne Cieminski,1 Nicolas Calteux,1 Catherine Coriell,1 Hollie Ulibarri,1 Julia Parise,1 Amanda Arroyo,1 Diana Chen,4 Maria Pierson,4 Rasa Rafie,5 Katelyn Sainz1 1Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA; 2International University of Health Sciences, Basseterre, St. Kitts; 3Fayoum University Faculty of Medicine, Fayoum, Egypt; 4Midwestern University College of Osteopathic Medicine, Glendale, AZ, USA; 5Rocky Vista University College of Osteopathic Medicine, Parker, CO, USACorrespondence: Greg MarchandMarchand Institute for Minimally Invasive Surgery, 10238 E. Hampton, Ste. 212, Mesa, AZ, 85209, USATel +1 4809990905Fax +1 4809990801Email gm@marchandinstitute.orgObjective: We set out to evaluate whether the instillation of bupivacaine versus a saline solution into the peritoneal cavity at time of laparoscopic gynecologic surgery will reduce postoperative pain and postoperative opioid consumption.Data Sources: We searched six databases: Web of Science, SCOPUS, Cochrane CENTRAL, ClinicalTrials.Gov, MEDLINE and PubMed. Our search strategy had no restriction on time or languages and included all studies that met our search algorithm up to March of 2021.Methods of Study Selection: We included only randomized trials that met our search strategy for the outcomes of 1) pain intensity 24 hours after surgery, 2) pain intensity 6 hours after surgery, and 3) length of hospital stay.Tabulation, Integration, and Results: We analyzed continuous data using mean difference (MD) with relative 95% confidence interval (CI). We included 8 randomized clinical trials. We found that intraperitoneal bupivacaine showed significant difference from the saline group regarding pain intensity 24 hours after surgery (MD= − 0.73 [− 1.10, − 0.36]) (P = 0.01) and pain intensity 6 hours after surgery (MD= − 1.12 [− 2.22, − 0.02]) (P = 0.05). Overall, patients allocated to the placebo group seemed to need other analgesics earlier than patients allocated to the bupivacaine group (MD=145.08 [51.37, 238.79] (P = 0.02)). There was no significant difference regarding the length of hospital stay (MD= − 0.44 [− 1.44, 0.56]) (P = 0.39).Conclusion: Bupivacaine significantly reduced the visual analog pain score for pain compared with that of the placebo at 6 and 24 hours postoperatively. There was no significant difference in hospital stay.Prospero Registration: CRD42021254268.Keywords: ERAS, marcaine, bupivacaine, enhanced recovery after surgery, intra-abdominal anesthetic