NO EFFECT OF CONTINUOUS I.P. INFUSION OF BUPIVACAINE ON POSTOPERATIVE ANALGESIA, PULMONARY FUNCTION AND THE STRESS RESPONSE TO SURGERY

Few clinicians would accept that analgesia in the postoperative period is adequate and that, at present, any regimen affords complete analgesia in every patient for any given situation. In addition, it may be argued that the hormonal response to surgical trauma is largely undesirable, resulting in erosion of body mass and tissue reserve, thus leading to an increase in surgical morbidity [1]. It is not possible to block this response following upper abdominal and thoracic procedures, and only extradural blockade is able to do so in the case of lower abdominal procedures [1, 2]. Thus the development, in these areas, of new ideas and techniques relevant to clinical practice is to be encouraged. The concept of instilling local anaesthetic into the peritoneum is not new, lignocaine and bupivacaine having been used with or without sedation for outpatient laparoscopy [3-6]. A recent study showed that a single intraoperative dose of bupivacaine reduced the period of postoperative colonic inhibition, and it was suggested that such a method may reduce the incidence of adynamic ileus. Furthermore, the authors noted a significant reduction in the hyperglycaemic stress response with i.p. bupi-vacaine, lasting for 4-8 h after the bolus dose [7]. The purpose of this study was to evaluate the effect of a continuous i.p. infusion of bupivacaine on analgesic requirements, pulmonary functio