Effect of pre-incisional and peritoneal local anesthetics administration on colon anastomosis and wound healing

Ulus Travma Acil Cerrahi Derg. 2024 May;30(5):316-322. doi: 10.14744/tjtes.2024.39551.

Abstract

Background: Previous research has shown that levobupivacaine is as effective as bupivacaine but carries a lower risk of cardiac and central nervous system toxicity. This study explores whether levobupivacaine and bupivacaine are preferable for all patients, includ-ing those with comorbidities, particularly focusing on their effects on colonic anastomosis. The primary objective is to examine the influence of levobupivacaine and bupivacaine on colonic anastomosis. Additionally, the study will assess their impact on wound healing and their anti-adhesive properties.

Methods: Conducted between July 28, 2022, to August 4, 2022, at the Hamidiye Animal Experiments Laboratory, this study was approved by the University Science Health, Hamidiye Animal Experiments Local Ethics Committee. This study was conducted using 21 male Sprague rats aged 16-20 weeks. The rats were allocated into three equal groups of seven each: Group C: pre-incisional isotonic; Group B: pre-incisional bupivacaine; and Group L: pre-incisional levobupivacaine. Macroscopic adhesion scores (MAS) were recorded during laparotomy and tissue samples were taken for histopathological examination and hydroxyproline levels measurement. Wound tensile strength along the middle incision line and anastomotic burst pressure were also assessed.

Results: MAS was statistically significantly lower in Groups B and L compared to Group C (p<0.001). The wound histopathology score (WHS) was significantly higher in Group L than in Group B (p=0.021). Colon histopathology scores (CHSs) were also signifi-cantly higher in Group L compared to Group C (p=0.011).

Conclusion: TThe study found that bupivacaine and levobupivacaine did not significantly enhance wound healing, although le-vobupivacaine significantly improved WHS relative to bupivacaine. According to the findings of this study, levobupivacaine can enhance clinical practice by being used in patients undergoing colon anastomosis. It contributes significantly to the durability of colon anasto-mosis, has a more positive effect on wound healing compared to bupivacaine, and exhibits anti-adhesive properties. Additional clinical trials are necessary to validate these results further.

MeSH terms

  • Anastomosis, Surgical*
  • Anesthetics, Local* / administration & dosage
  • Anesthetics, Local* / pharmacology
  • Animals
  • Bupivacaine* / administration & dosage
  • Bupivacaine* / analogs & derivatives
  • Bupivacaine* / pharmacology
  • Colon* / pathology
  • Colon* / surgery
  • Levobupivacaine* / administration & dosage
  • Male
  • Rats
  • Rats, Sprague-Dawley*
  • Tissue Adhesions / prevention & control
  • Wound Healing* / drug effects

Substances

  • Anesthetics, Local
  • Levobupivacaine
  • Bupivacaine