The Impact of Intraperitoneal Levobupivacaine on Pain Relief After Laparoscopic Cholecystectomy: A Meta-analysis of Randomized Controlled Studies. Issue 1 (February 2020) - Wei, Xuan
Abstract : Introduction: The influence of intraperitoneal levobupivacaine on pain relief after laparoscopic cholecystectomy remains controversial. We conducted a systematic review and meta-analysis to explore the impact of intraperitoneal levobupivacaine versus placebo on pain intensity after laparoscopic cholecystectomy. Materials and Methods: We searched the PubMed, Embase, Web of Science, EBSCO, and Cochrane Library databases through March 2019 for randomized controlled trials assessing the effect of intraperitoneal levobupivacaine versus placebo on pain intensity after laparoscopic cholecystectomy. This meta-analysis is performed using the random-effect model. Results: Six randomized controlled trials are included in the meta-analysis. Overall, compared with the control group after laparoscopic cholecystectomy, intraperitoneal levobupivacaine is associated with substantially reduced pain scores at 2 hours [standard mean difference (SMD)=−0.70; 95% confidence interval (CI)=−1.04 to −0.37; P <0.0001], 4 hours (SMD=−0.61; 95% CI=−0.90 to −0.32; P <0.0001), and 12 hours postoperatively (SMD=−0.31; 95% CI=−0.60 to −0.03; P =0.03), and analgesic requirement (SMD=−0.83; 95% CI=−1.48 to −0.19; P =0.01), but reveals no obvious impact on pain scores at 24 hours postoperatively (SMD=0.09; 95% CI=−0.64 to 0.83; P =0.80) and the incidence of nausea or vomiting (risk ratio=0.69; 95% CI=0.40-1.20; P =0.19). Total adverse events in the levobupivacaine group seem to be lower than that in the control group (risk ratio=0.57; 95% CI=0.38-0.85; P =0.006). Conclusion: Intraperitoneal levobupivacaine provides additional benefits for pain relief after laparoscopic cholecystectomy.