Use of Intraperitoneal and Port Site Infiltration of Bupivacaine for Controlling Pain after Laparoscopic Cholecystectomy: A Prospective Study
Abstract
Purpose: Pain after laparoscopic cholecystectomy is less intense than after open cholecystectomy, some patients still experience considerable discomfort especially with coughing, respiratory movements and mobilization during initial few hours after surgery or during night after surgery. Material and Methods: Study included 200 patients who underwent laparoscopic cholecystectomy. They were divided into two groups of 100 patients each. One group (experimental) received bupivacaine and other group (Control) received 30 ml of normal saline after completion pf laparoscopic cholecystectomy. Results: Mean time of requirement of rescue analgesia in experimental group was 8.5 hours, whereas mean time of requirement of rescue analgesia in controls was 7.29 hrs. Total consumption of diclofenac in cases was 95mg whereas in controls it was 108.75mg (p=0.246), while as total consumption of tramadol in cases was 50 mg, whereas in controls it was 130mg (p<0.05). Postoperative abdominal pain as well as shoulder tip pain were less at all-time intervals (4h, 12h, and 24h) in cases compared to controls. Only 2 patients developed bradycardia and 1 patient developed mild drowsiness in experimental group in post-operative period. All the 3 patients required only monitoring and settled in 3-4 hours. Mean hospital stay in experimental group was 1.71 days, whereas in controls it was 1.93 days. Conclusion: Intraperitoneal and port site bupivacaine significantly reduces both somatic and visceral components of pain in post-operative period in laparoscopic cholecystectomy. It decreases the requirement of rescue analgesia and expedites discharge of patient from hospital.
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- Brett M, Baker DJ. World distribution of gall stones. Int J Epidemiol. 1976;5:335.
- Brasca A, Berli D, Pezzotto SM. Morphological and demographic associations of biliary symptoms in subjects with gallstones: findings from a population- based survey in Rosario, Argentina. Dig Liver Dis. 2002;34:577-81.
- Graves HA, Jeanne F, William JA. Appraisal of laparoscopic cholecystectomy. Annals of Surgery. 1991;213:655-64.
- Saleh M, Salamah AL. Outcome of laparoscopic cholecystectomy in acute cholecystitis. JCPSP. 2005;15:400-3.
- Ji W, Ding K, Li LT, Wang D, Li N, Li JS. Outpatient versus inpatient laparoscopic cholecystectomy: A single center clinical analysis. Hepatobiliary Pancreat Dis Int. 2010;9:604.
- Joris J, Cigarini I, Legrand M, et al. Metabolic and respiratory changes after cholecystectomy performed via laparotomy or laparoscopy. Br J Anaesth. 1992;69:341-5.
- Joris J, Thiry E, Paris P, Weerts J, Lamy M. Pain after laparoscopic cholecystectomy: characteristics and effect of intraperitoneal bupivacaine. Anesth Analg. 1995;81:379-84. Coelioscopie ambulatoire. Cah Anesthesiol. 1993;41:385-91.
- Jakson SA, Laurence AS, Hill JC. Does post- laparoscopy Pain relate to residual carbondioxide? Anaesthesia. 1996;8:441-5.
- Kum CK, Wong CW, Goh PM, Ti TK. Comparative study of pain level and analgesic requirement after laparoscopic and open cholecystectomy. Surg Laparosc Endosc. 1994;4:139-41.
- Dath D, Park AK. Randomized, controlled trial of bupiva-caine injection to decrease pain after laparoscopic cholecystectomy. Can J Surg. 1999;42:284–8.
