The efficacy of topical bupivacaine and triamcinolone acetonide injection in the relief of pain after endoscopic submucosal dissection for gastric neoplasia: a randomized double-blind, placebo-controlled trial

Bun Kim, Hyuk Lee, Hyunsoo Chung, Jun Chul Park, Sung Kwan Shin, SangKil Lee, Yongchan Lee

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background: Although pain is a common complication of endoscopic submucosal dissection (ESD), management strategies are inadequate. The aim of this study was to evaluate the efficacy of topical bupivacaine and triamcinolone acetonide for abdominal pain relief and as a potential method of pain control after ESD for gastric neoplasia. Methods: In this randomized, double-blind, placebo-controlled trial, 111 eligible patients with early gastric neoplasm were randomized into one of three groups: Bupivacaine (BV) only, bupivacaine with triamcinolone (BV-TA), or placebo. The present pain intensity (PPI) score and the Short-Form McGill Pain Questionnaire (SF-MPQ) were used to evaluate pain at 0, 6, 12, and 24 after ESD. Results: The mean values for the 6-hour PPI in the BV-TA and BV groups were lower than those of the placebo group (1.57±1.09 and 1.97± 1.09 vs. 2.63 ± 0.98, p< 0.001). The 12-hour PPI of the BV-TA group (1.20±0.83) was the lowest among the three groups (p=0.001). The total 6-hour SF-MPQ score, especially in the sensory domain, was higher in the placebo group than in BV and BV-TA groups. The 12-hour SF-MPQ score was the lowest in the BV-TA group. Multivariate analysis demonstrated that BV-TA injection protocol, fibrosis, and size of residual ulcer were independently associated with the PPI score at 6. Conclusion: Bupivacaine after ESD was effective for pain relief at 6 postoperatively. Particularly, topical infiltration of bupivacaine mixed with triamcinolone acetonide was helpful for producing a more long-lasting benefit of pain relief after gastric ESD.

Original languageEnglish
Pages (from-to)714-722
Number of pages9
JournalSurgical endoscopy
Volume29
Issue number3
DOIs
Publication statusPublished - 2014 Jul 25

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Triamcinolone Acetonide
Bupivacaine
Stomach
Placebos
Pain
Injections
Neoplasms
Pain Measurement
Endoscopic Mucosal Resection
Triamcinolone
Abdominal Pain
Ulcer
Stomach Neoplasms
Fibrosis
Multivariate Analysis

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

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title = "The efficacy of topical bupivacaine and triamcinolone acetonide injection in the relief of pain after endoscopic submucosal dissection for gastric neoplasia: a randomized double-blind, placebo-controlled trial",
abstract = "Background: Although pain is a common complication of endoscopic submucosal dissection (ESD), management strategies are inadequate. The aim of this study was to evaluate the efficacy of topical bupivacaine and triamcinolone acetonide for abdominal pain relief and as a potential method of pain control after ESD for gastric neoplasia. Methods: In this randomized, double-blind, placebo-controlled trial, 111 eligible patients with early gastric neoplasm were randomized into one of three groups: Bupivacaine (BV) only, bupivacaine with triamcinolone (BV-TA), or placebo. The present pain intensity (PPI) score and the Short-Form McGill Pain Questionnaire (SF-MPQ) were used to evaluate pain at 0, 6, 12, and 24 after ESD. Results: The mean values for the 6-hour PPI in the BV-TA and BV groups were lower than those of the placebo group (1.57±1.09 and 1.97± 1.09 vs. 2.63 ± 0.98, p< 0.001). The 12-hour PPI of the BV-TA group (1.20±0.83) was the lowest among the three groups (p=0.001). The total 6-hour SF-MPQ score, especially in the sensory domain, was higher in the placebo group than in BV and BV-TA groups. The 12-hour SF-MPQ score was the lowest in the BV-TA group. Multivariate analysis demonstrated that BV-TA injection protocol, fibrosis, and size of residual ulcer were independently associated with the PPI score at 6. Conclusion: Bupivacaine after ESD was effective for pain relief at 6 postoperatively. Particularly, topical infiltration of bupivacaine mixed with triamcinolone acetonide was helpful for producing a more long-lasting benefit of pain relief after gastric ESD.",
author = "Bun Kim and Hyuk Lee and Hyunsoo Chung and Park, {Jun Chul} and Shin, {Sung Kwan} and SangKil Lee and Yongchan Lee",
year = "2014",
month = "7",
day = "25",
doi = "10.1007/s00464-014-3730-4",
language = "English",
volume = "29",
pages = "714--722",
journal = "Surgical Endoscopy",
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T1 - The efficacy of topical bupivacaine and triamcinolone acetonide injection in the relief of pain after endoscopic submucosal dissection for gastric neoplasia

T2 - a randomized double-blind, placebo-controlled trial

AU - Kim, Bun

AU - Lee, Hyuk

AU - Chung, Hyunsoo

AU - Park, Jun Chul

AU - Shin, Sung Kwan

AU - Lee, SangKil

AU - Lee, Yongchan

PY - 2014/7/25

Y1 - 2014/7/25

N2 - Background: Although pain is a common complication of endoscopic submucosal dissection (ESD), management strategies are inadequate. The aim of this study was to evaluate the efficacy of topical bupivacaine and triamcinolone acetonide for abdominal pain relief and as a potential method of pain control after ESD for gastric neoplasia. Methods: In this randomized, double-blind, placebo-controlled trial, 111 eligible patients with early gastric neoplasm were randomized into one of three groups: Bupivacaine (BV) only, bupivacaine with triamcinolone (BV-TA), or placebo. The present pain intensity (PPI) score and the Short-Form McGill Pain Questionnaire (SF-MPQ) were used to evaluate pain at 0, 6, 12, and 24 after ESD. Results: The mean values for the 6-hour PPI in the BV-TA and BV groups were lower than those of the placebo group (1.57±1.09 and 1.97± 1.09 vs. 2.63 ± 0.98, p< 0.001). The 12-hour PPI of the BV-TA group (1.20±0.83) was the lowest among the three groups (p=0.001). The total 6-hour SF-MPQ score, especially in the sensory domain, was higher in the placebo group than in BV and BV-TA groups. The 12-hour SF-MPQ score was the lowest in the BV-TA group. Multivariate analysis demonstrated that BV-TA injection protocol, fibrosis, and size of residual ulcer were independently associated with the PPI score at 6. Conclusion: Bupivacaine after ESD was effective for pain relief at 6 postoperatively. Particularly, topical infiltration of bupivacaine mixed with triamcinolone acetonide was helpful for producing a more long-lasting benefit of pain relief after gastric ESD.

AB - Background: Although pain is a common complication of endoscopic submucosal dissection (ESD), management strategies are inadequate. The aim of this study was to evaluate the efficacy of topical bupivacaine and triamcinolone acetonide for abdominal pain relief and as a potential method of pain control after ESD for gastric neoplasia. Methods: In this randomized, double-blind, placebo-controlled trial, 111 eligible patients with early gastric neoplasm were randomized into one of three groups: Bupivacaine (BV) only, bupivacaine with triamcinolone (BV-TA), or placebo. The present pain intensity (PPI) score and the Short-Form McGill Pain Questionnaire (SF-MPQ) were used to evaluate pain at 0, 6, 12, and 24 after ESD. Results: The mean values for the 6-hour PPI in the BV-TA and BV groups were lower than those of the placebo group (1.57±1.09 and 1.97± 1.09 vs. 2.63 ± 0.98, p< 0.001). The 12-hour PPI of the BV-TA group (1.20±0.83) was the lowest among the three groups (p=0.001). The total 6-hour SF-MPQ score, especially in the sensory domain, was higher in the placebo group than in BV and BV-TA groups. The 12-hour SF-MPQ score was the lowest in the BV-TA group. Multivariate analysis demonstrated that BV-TA injection protocol, fibrosis, and size of residual ulcer were independently associated with the PPI score at 6. Conclusion: Bupivacaine after ESD was effective for pain relief at 6 postoperatively. Particularly, topical infiltration of bupivacaine mixed with triamcinolone acetonide was helpful for producing a more long-lasting benefit of pain relief after gastric ESD.

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