Bupivacaine intermittent wound irrigation is an effective and cost­ reducing modality for postoperative analgesia after open cholecystectomy

Abstract

Objectives:To evaluate postoperative outcome of open cholecystectomy in patients receiving local anesthetic (LA) wound irrigation (WI) for postoperative (PO) analgesia. Patients & methods: The study included 40fomale patients with mean age of34.1±3.4 years. All surgeries were peiformed through Kocher's subcostal incision, during muscle cutting, the neurovascular bundle was identified and after peritoneal drainage and closure, an 8F neonatal feeding catheter with fashioned multiple pores was inserted partly between anterior abdominal wall muscles and partly under subcutaneous tissue directly on the neurovascular bundle. Patients were divided into: Control group (Group C) who received WI using 0.9% saline and study group (GroupS) who received 8-hourly WI using 20 ml ofbupivacaine 0.25%for 48 hours. Wound pain was assessed using 10-mm visual analogue scale (VAS). Duration of PO analgesia and frequency of requests and total dose of intravenous mepridine, time for first ambulation and oral intake were recorded. All patients were discharged after irrigation catheter removal on the morning of the 3rd PO day. Results: All surgeries were completed uneventfully without complications within a mean operative time of 46.5±5.3 minutes. Patients who received LA irrigation showed significantly longer duration of analgesia with significantly lower frequency of requests and total dose of mepridine and lower cumulative VAS pain score compared to control group. Mean time tilllst ambulation and oral intake was significantly shorter in Group S compared to group C. Seven patients had postoperative nausea and/or vomiting (PONV), 4 in control and 3 in study group and only one patient in control group required stoppage of oral intake, but all patients responded well to antiemetic therapy. Conclusion: Wound irrigation with bupivacaine significantly improved outcome of open cholecystectomy and could be advocated for various open surgical procedures. The applied modality was safe, effective and cost reducing with significant opioid sparing effect.