Preincisional infiltration and intraperitoneal instillation of levobupivacaine 0.25% for management of early postoperative pain following laparoscopic ovarian drilling Mohamed Taha Ismail 1 , Maher Z. Hassanin 2 and Nagat S. Elshmaa 2 1 Department of Obstetrics and Gynecology, Ain Shams University, Cairo and 2 Department of Anesthesiology, Tanta University, Tanta, Egypt Abstract Aim: To assess the effectiveness of combined preincisional local infiltration (at trocar sites) and intraperitoneal instillation of levobupivacaine 0.25% for the management of early postoperative pain following laparoscopic ovarian drilling. Materials and Methods: This is a prospective randomized controlled observer-blinded study. The study included 106 infertile patients with the diagnosis of polycystic ovary syndrome (PCOS) who were sche- duled to undergo diagnostic laparoscopy and laparoscopic ovarian drilling (LOD) during the period from November 2009 to February 2012 at TAIBA Hospital in Kuwait. Patients were randomly allocated to two groups of 53 patients each. Group I comprised patients who received preincisional local infiltration and intraperitoneal instillation levobupivacaine 0.25%. Patients in group II received equal volumes of normal saline 0.9% (NS) at the same sites. The primary outcome measures were visual analog scale pain scores and postoperative analgesic consumption. Results: Postoperative average VAS pain scores, i.m. pethidine consumption and i.v. paracetamol consump- tion during the first 24h were highly significantly lower in the levobupivacaine group compared to the NS group (P < 0.01). This technique was also associated with significantly higher overall patient satisfaction, shorter hospital stay and more rapid resumption of normal activity (P < 0.01) without any significant adverse events. Conclusion: The combination of preincisional local infiltration and intraperitoneal instillation of levo- bupivacaine 0.25% was found to substantially reduce postoperative pain and the consumption of post- operative analgesics during the first 24h; and shorten hospital stay and time to resume normal activities after LOD. It was also associated with a very high overall patient satisfaction without any significant adverse events. Key words: intraperitoneal, laparoscopic ovarian drilling, levobupivacaine, postoperative pain. Introduction Polycystic ovary syndrome (PCOS) is the most fre- quent endocrine disease in women of reproductive age, with prevalence in the general population ranging between 5 and 10% according to its definition. 1 Laparoscopic ovarian drilling (LOD) is a treatment option for clomiphene citrate-resistant infertile women with PCOS. It has been reported that LOD leads to induction of spontaneous ovulation in 30–90% of women undergoing this procedure. 2 Received: May 1 2012. Accepted: June 16 2012. Reprint request to: Dr Mohamed Taha Ismail, TAIBA Hospital, Sabah Al-Salem Area, Block 2, Street 2, Al-Messila Towers, Tower No. 3, Flat No. 342, Kuwait. Email: drmohamed_taha@yahoo.com doi:10.1111/j.1447-0756.2012.01989.x J. Obstet. Gynaecol. Res. Vol. 39, No. 2: 543–548, February 2013 © 2012 The Authors 543 Journal of Obstetrics and Gynaecology Research © 2012 Japan Society of Obstetrics and Gynecology