Randomized clinical trial of combined preincisional infiltration and intraperitoneal instillation of levobupivacaine for postoperative pain after laparoscopic cholecystectomy (Br J Surg 2011; 98: 784-789).

摘要

We read with great interest the article by Hilvering and colleagues about the use of combined prein-cisional and intraperitoneal administration of levobupivacaine to prevent postoperative pain after laparoscopic cholecystectomy. We believe, however, that several factors must be taken into consideration before drawing formal conclusions from the results presented.We totally agree with the authors when they stated that postoperative complications should not be related to possible side-effects of levobupivacaine. We are concerned about the higher incidence of complications in the treatment group that was close to statistical significance (P = 0-056 when pooling all complications). The difference reached significance when considering possible complications in the patient not included in analysis (P = 0-029, Fisher's exact test). One may speculate that a twofold higher complication rate in the levobupivacaine group might have influenced the results. Bile and blood are well documented stimuli of chemical peritoneal irritation and inflammation that may influence pathophysiological pain mechanisms. It might explain unexpected results and discrepancies with available data from previously published studies.