The Effectiveness of Bupivacaine Instillation on Postoperative Pain after Elective Laparoscopic Cholecystectomy: A Prospective Randomized Controlled Trial

Year 2019, Volume: 5 Issue: 1, 26 - 33, 01.01.2019

Rabia Arshad Kamran Munir Bajwa Mishal Sikander Rakhshanda Rashid

https://doi.org/10.5455/umj.20190130080233

Abstract

Background: The gold-standard procedure for the surgical treatment of gallstone disease is Laparoscopic Cholecystectomy. With better pain management Laparoscopic Cholecystectomy can be practiced as Day-case surgery by the reduction in post-op pain, reduced analgesia demand, early mobility, and shorter hospital stay. Materials and Methods: This study was conducted at the department of general surgery, Pakistan Institute of Medical Sciences PIMS Complex, Islamabad from July 2016 to January 2018. A total of 164 patients were selected for the study. Patients aged 13 and above who were diagnosed with symptomatic cholelithiasis, gall bladder polyps or sludge were included in the study. Informed consent was taken. The patients were classified into two groups based on the intervention by instillation of Bupivacaine in one group and no intervention in the other. Results: Out of these 82 50% were installed with bupivacaine at the final stage of closure at peritrocar, sub-phrenic and gallbladder bed and in remaining 82 no instillation of any drug at aforementioned sites was done. The outcome was measured between these two groups in terms of time for first demand of analgesia, the frequency of the demand by the patient, time to mobility and post-op hospital stay. Conclusion: This study showed that there was a significant difference in the outcome of instillation of bupivacaine in subphrenic space, gall bladder bed and peritrocal site on Postoperative Pain after Elective Laparoscopic Cholecystectomy.

Keywords

Laparoscopic cholecystectomy, cholelithiasis, VAS, bupivacaine, postoperative pain

References

• Csikesz NG, Singla A, Murphy MM. Surgeon volume metrics in laparoscopic cholecystectomy. Dig Dis Sci ;55:2398-99.
• Muhammad NM. Experience of Laparoscopic Chole cystectomy Pak Armed Forces Med J 1996;46(2):59-61.
• Soper NJ, Stockmann PT, Dunnegan DL, Ashley SW. Laparoscopic cholecystectomy. The new 'gold standard'? Arch Surg 1992; 127:917-20.
• Kamran A, Mohammad Z, Mohammad AW. Comparison of operative stress after open & Laparoscopic Cholecystectomy.Pak J Surg 2008;24(2):83-6.
• Adnan M, Muhammad AN, Shizan HF, Haroonur R. Laparoscopic cholecystectomy: an audit of 500 patients.J Ayub Med Coll Abbottabad 2011;23(4):88-90.
• Yamakawa T, Fukuda N.History of surgery for cholelithiasis: from era of cholecystostomy to laparoscopic surgery. Nihon Geka Gakkai Zasshi. 2000; 101(12):877-81.
• Muhammad Iqbal. Future of Minimally Invasive Surgery in Pakistan. Rawal Med J 2008;33(2):130.
• David EJ, and Marshall MK. Pathogenesis and Treatment of Gallstones. EnglJMed 1993; 328:412-421.
• Mohamed I. S, Shawkat S.G, Khalid S.S. Laparoscopic Cholecystectomy as a Day Surgery Procedure: Is it Safe?— An Egyptian Experience. Saudi J Gastroenterol. 2011; (4):277–279.
• Singla S, Mittal G, Raghav.Pain management after laparoscopic cholecystectomy-a randomized prospective trial of low pressure and standard pressure pneumo peritoneum. J Clin Diagn Res. 2014 Feb;8(2):92-4.
• Stinton LM, Myers RP, Shaffer EA. Epidemiology of gallstones. Gastroenterol Clin North Am.2010;39:157-169.
• Tamhankar F, Mazari J. Postoperative Symptoms, After- Care, and Return to Routine Activity After Laparoscopic Cholecystectomy. JSLS. 2010 Oct-Dec; 14(4): 484–489.
• Choi G. Effect of intraperitoneal local anesthetic on pain characteristics after laparoscopic choecystectomy. World Journal of Gastroenterology. 2015;21(47):13386.
• Bisgaard T, Kehlet H, Rosenberg J. Pain and convalescence after laparoscopic cholecystectomy. Eur J Surg. 2001;167 (2):84-96.
• Jljri V, Kogler-Majeric. Intraperitoneal bupivacaine for analgesia after laparoscopic cholecystectomy.Acta Anaesthesiol Scand 1997; 41:193-196.
• Chundrigar T, Hedges AR, Morris R. Intraperitoneal bupivacaine for effective pain relief after laparoscopic cholecystectomy. Ann R Coll Surg Engl. 1993;75(6):437-9.
• Ebrahimifard F, Nooraei N. Postoperative pain after laparoscopic cholecystectomy: a randomized clinical trial comparing intraperitoneal bupivacaine versus intravenous pethidine. Surg Laparosc Endosc Percutan Tech. 2013 Feb;23(1):88-92.
• Sharma CS, Singh M, Rautela RS, Kochhar A, Adlakha N. Comparison of intraperitoneal and periportal bupivacaine and ropivacaine for postoperative pain relief in laparoscopic cholecystectomy: a randomized prospective study. Anaesth Pain & Intensive Care 2014;18(4):350-54.
• Chun-NY ,Chun-YT, Chi-TC. Pain relief from combined wound and intraperitoneal local anesthesia for patients who undergo laparoscopic cholecystectomy. BMC Surg ; 14:28. Susanne M. Intraperitoneal Bupivacaine Does Not Effectively Reduce Pain After Laparoscopic Cholecystectomy: A Randomized, Placebo-Controlled and Double-Blind Study.Surgical Laparoscopy, Endoscopy & Percutaneous Techniques 2000; 10(6) : 357-359.
• Kuthiala G, Chaudhary G. Ropivacaine: A review of its pharmacology and clinical use. Indian J Anaesth 2011; (2):104-110.