Effect of intra-abdominal bupivacaine instillation on postoperative colonic motility

Abstract

Effect of intra-abdominal instillation of a local anaesthetic, bupivacaine, on postoperative colonic adynamic ileus was studied in a double blind manner in a randomised series of patients undergoing upper laparotomy. Propulsive colonic activity was studied postoperatively with radio-opaque markers and serial abdominal radiographs. Intra-abdominal instillation of bupivacaine 2 mg/kg bw significantly shortened the period of postoperative colonic inhibition (p<0·01), but did not hasten colonic transit. Furthermore, bupivacaine significantly decreased the hyperglycaemic response to surgery. It is suggested that bupivacaine inhibits the inflammatory response within the bowel wall, a response which may maintain the inhibitory spinal reflexes in the postoperative period. Blood concentrations of bupivacaine were shown to be well below toxic levels and no adverse reactions were observed.