It Seemed Like a Good Idea

Anchorage to Denali - photo by JoAnn Sturman

Scott Sturman, M.D.

Once upon a time an obstetrician returned from a conference with a new idea and began injecting large volumes of intraperitoneal bupivacaine for post op pain relief at the conclusion of caesarean sections.  This may have had some benefit in the era before spinal anesthesia with intrathecal narcotics became the standard of practice, but times have changed.

Owing to the large surface area and generous blood supply, local anesthetic is rapidly absorbed from the peritoneal cavity.  Blood levels can be unacceptably high, especially in the case when intraperitoneal bupivacaine is combined with TAP blocks after general anesthesia.  From a pure pharmacokinetic standpoint, the duration of pain relief from intraperitoneal medications is much shorter than that of intrathecal morphine.  The benefit is exceedingly small. The practice is antiquated and should be abandoned. 

Hard Rock, Bucharest - photo by JoAnn Sturman