Surgicel® fibrillar as an innovative analgesic reservoir for post-laparoscopic cholecystectomy pain management: Randomized double-blind trial

Abstract

ABSTRACT Background Strong analgesia is still needed after laparoscopic cholecystectomy (LC). Surgicel® is a haemostatic agent, capable of absorbing fluids several times its volume, although pain is lower than after open surgeries. We hypothesized that Surgicel® could function as an innovative carrier for sustained-release postoperative analgesia. Methods Ninety patients (18–65 years) scheduled for LC were randomized to receive a mixture of 20 ml bupivacaine 0.5%, 10 ml lidocaine 2%, epinephrine 5 µg/ml, and morphine 0.1 mg/kg instilled at hepatic fossa, trocar sites, and under the right copula of the diaphragm (Group-I). Group-II received similar mixture to soak Surgicel® applied at the hepatic fossa and trocar sites. Group-III received normal saline to soak Surgicel® at the same locations. Visual analog scale at 1, 2, 4, 6, 12, and 24 h postoperatively was the primary outcome, while the secondary outcomes included Verbal rating scale, time to first rescue analgesia, total 24-h analgesia, time for the return of bowel function, patients’ satisfaction, and adverse effects. Results Group-II showed the lowest pain scores (p > 0.05), the longest time before requesting analgesia (p = 0.004), used least extra analgesia (p ≤ 0.001), maintained highest satisfaction scores (p ≤ 0.001), and lowest complications (p = 0.048). Group-I showed better results regarding pain control compared to group-III after 2 h (p = 0.02) with prolonged time to first analgesia (p < 0.001) and less analgesic consumption (p < 0.001). Conclusion Application of Surgicel® as a reservoir of analgesics at the potential pain generating sites following laparoscopic cholecystectomy, resulted in superior and extended postoperative analgesia with better patients’ satisfaction, and no serious adverse effects.