Assessment of Effect of Port Site and Intraperitoneal Instillation of Bupivacaine in Reduction of Post-Operative Pain After Laparoscopic Cholecystectomy

Abstract

Aim: Effective postoperative pain control is an essential component for care of surgical patients. Inadequate pain control may result in increased morbidity or mortality. Analgesic effects of periportal infiltration of local anesthetics, infiltration of periportal parietal peritoneum, intraperitoneal spraying at subdiaphragmatic space and subhepatic space covering the area of hepatoduodenal ligament have been reported. The present controlled study aimed at assessing the effect of port site injection and intraperitoneal instillation of bupivacaine in reduction of post-operative pain after laparoscopic cholecystectomy. Methods: The present study was conducted among a group of 180 patients diagnosed to have symptomatic cholelithiasis and who underwent elective laparoscopic cholecystectomy under general anesthesia. In group 1, pre-incisional local infiltration of 20ml 0.5% bupivacaine at the port sites; and in group 2, local infiltration of 20ml 0.5% bupivacaine at the port sites with intraperitonial installation. In group 3, no local infiltration was done and treated as control group. Pain assessment is based on a Universal Pain Assessment Tool. Analysis of our study was performed one-way ANOVA & Post HOC test (Scheffe's HSD) & Chi square tests as and when indicated. Results: Mean pain scores at 30 minutes were significantly lower in groups 1 & 2 compared to control group; but however, the values were not significantly different when compared to each other. Similarly, the mean pain scores at 4th, 8th, 16th and 24th hours for the preincisional and preclosure groups, didn't signify any inter-group advantage. Therefore, bupivacaine provides a substantial reduction of pain intensity up to 24 hours postoperatively; and was found to be statistically significant. However, timing of anesthesia was found to be statistically insignificant in terms of preclosure vs pre incisional of the port sites. Conclusion: Instillation of bupivacaine at the port sites in laparoscopic cholecystectomy irrespective of the timing of instillation is an effective method of achieving pain control in the post-operative period as long as 24 hours after surgery. There was no statistically significant reduction of post-operative pain between the pre-incisional and pre-closure groups.