Abstract
Purpose: Gallbladder is highly innervated by parasympathetic and sympathetic nervous system through anterior and posterior hepatic plexus and the phrenic nerves. The aim of this study was to evaluate the effect of bupivacaine irrigated at the surgical bed on postoperative pain relief in laparoscopic cholecystectomy patients. and reducing analgesic consumption following laparoscopic cholecystectomy. Methods: This randomized controlled prospective study included 150 patients undergoing elective laparoscopic cholecystectomy who were prospectively randomized into 2 groups. The placebo group (n=75) received 50cc normal saline in- stalled into the gallbladder bed after removal of the gall bladder. The bupivacaine group (n=75) received 20cc of 0.5% bupivacaine in at the same surgical site. Pain was assessed at 1,2 ,6, 12, and 24 hours by using a visual analog scale (VAS). Results: The postoperative visual analogue score within the first 24 hour for visceral pain at rest, during coughing, and movement was significantly lower in the infiltration group than the control group, but it was similar for somatic pain. Time to first rescue analgesia was significantly longer in the infiltration than the control group. significant difference (P=.011) was observed in pain levels between both groups at 2, and 6 hours postoperatively. The average analgesic requirement was lower in the bupivacaine group. Conclusions: In our study, the use of bupivacaine irrigated over the surgical bed was an effective method to decreased visceral pain intensity at rest, coughing, and movement with reduced analgesic consumption in the first postoperative 24 hours after laparoscopic cholecystectomy.
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