Effect of local anesthetic instillation intraperitoneally on post-op pain relief after laparoscopic cholecystectomy

Abstract

Background: To determine the effect of local anesthetic intraperitonel instillation on post-op pain relief after laparoscopic cholecystectomy. Methods: In this randomized controlled trial 64 patients, diagnosed as having gall-stones, were divided into 2 groups for laparoscopic cholecystectomy. In Group A Intraperitoneal irrigation of the diaphragmatic surface and gallbladder fossa was done with 0.5% bupivacaine, while in Group B no drug was used intraperitoneally. Results: Out of 32 patients enrolled as bupivacaine group, 27 were female and 5 were male patients with average age of 46.12 years, whereas in control group, there were 28 female and 04 male patients in a total of 32 patients, and the avrage age was 45.36 years. Mean VAS scores in bupivacaine group at 8, 16 and 24 hrs were 3.875, 2.5625 and 0.75 respectively, while they were 6.50, 3.25 and 0.875 in controls at 8, 16 and 24hrs respectively. VAS scores tended to be higher in females. Need for post-op analgesia in 1st 8hrs & 1st 16hrs was more in the controls(87.50% & 56.25% respectively). The need for post-op analgesia at 24hrs after surgery was almost equal in both groups. Post-op pain relief in 1st 8hrs was better in the bupivacaine group i.e. 31.25% vs. 12.5%. Conclusion: The early post-op VAS scores and pain intensity after 8hrs & 16hrs is decreased with the use of intra-peritoneal instillation of injection Bupivacaine, but in long term it offers no added benefit to the post-operative pain relief and does not decrease the need for analgesia post-operatively. Keywords: Bupivacaine, Diaphragmatic surface, Gall bladder fossa, Post-operative pain relief, Laparoscopic Cholecystectomy