۱- Introduction

۲- Materials and methods

۳- Results

۴- Discussion

۵- Conclusions

References

Introduction

Gynecologic endoscopic surgery, in particular, has seen tremendous advances. Breakthroughs in video technology, instrumentation, adhesion prevention, and computer-enhanced technology have certainly allowed surgeons to routinely perform a number of procedures endoscopically rather than by laparotomies. These innovations have contributed to faster recovery time, smaller scars, less adhesion formation, fewer complications, lower cost, and, most importantly, better results [1]. However, patients undergoing laparoscopic procedures experience post-operative pain, especially in the upper and lower abdomen, back, and shoulder region. Pain intensity usually peaks during the first post-operative hours and usually declines over the following 2–۳ days [2]. Pain after laparoscopy results from the stretching of the intra-abdominal cavity, peritoneal inflammation and phrenic nerve irritation caused by residual CO2 in the peritoneal cavity [3]. Local pain is associated with incisions for the operative ports. Lower abdominal pain may depend on the extent of intraperitoneal manipulation during diagnostic laparoscopy [4]. The worst pain after gynecological laparoscopic surgery was felt in the shoulder in 1% of the patients, two hours after surgery but in 70% of the patients 24 h after surgery [5]. Pain attributed to intraperitoneal gas was as frequent as abdominal wall pain at 24 h, but declined markedly by 48 h, along with a corresponding reduction in the retained gas shown on X-ray [6]. Incisional pain is usually mild to moderate in intensity and maximal immediately postoperatively, subsiding with time [7]. Although opioids provide powerful analgesia in the treatment of post-operative pain, they may lead to adverse effects such as sedation, nausea, vomiting and gastrointestinal ileus [8]. The aim of our study was to evaluate the role of intraperitoneal and port site use of local anesthetic agents in gynecological laparoscopy for post-operative pain relief.