Efficacy of Intraperitoneal Bupivacaine, Hydrocortisone, and Magnesium Sulfate in Different Combinations for Pain Relief After Laparoscopic Ovarian Cystectomy: a Double-blind Randomized Controlled Trial

Background: The aim of this study was to assess the efficacy of intraperitoneal different combinations for postoperative pain relief in patients undergoing laparoscopic unilateral ovarian cystectomy.

Methods: We conducted a double-blind randomized controlled trial that enrolled patients who were included to undergo laparoscopic unilateral ovarian cystectomy. Patients received one of the following combinations (30 patients each): group I: received bupivacaine plus magnesium sulfate, group II: received bupivacaine plus hydrocortisone, group III: received magnesium sulfate plus hydrocortisone, and group IV: received saline 0.9% only. The primary outcomes in the present study were the severity of postoperative abdominal and shoulder pain assessed by visual analog scale (VAS) every two hours till the end of the first day, and time for first postoperative analgesia requirement.

Results: Group I had statistically significant lower abdominal static and dynamic pain scores than the other groups till 18 hours postoperatively (P<0.001). In addition, group II had statistically significant lower abdominal static and dynamic pain scores than group III in the most of assessment points (P<0.05). The time for first required analgesics was significantly longer in group I (336.2±67.54 minutes) than other groups (P<0.001). The proportion of patients who required two or more doses of ketorolac was significantly lower in group I than other groups (P<0.001). The proportion of patients with nausea or vomiting was not significantly different across study's groups (P>0.05).

Conclusions: Intraperitoneal bupivacaine-magnesium combination provides better analgesia and reduces postoperative morphine consumption than bupivacaine-hydrocortisone or magnesium-hydrocortisone combinations after laparoscopic ovarian cystectomy.