Intraperitoneal Bupivacaine Research Articles

Evaluation of preoperative intraperitoneal injection of bupivacaine for intraoperative antinociception in cats undergoing ovariohysterectomy: A randomized clinical trial

ObjectiveTo determine if preoperative intraperitoneal bupivacaine can minimize intra- and postoperative nociception/pain in cats undergoing ovariohysterectomy. Study designProspective, randomized, investigator-blinded, placebo-controlled clinical trial. AnimalsForty-seven, intact female cats. MethodsCats were anesthetized using a standard protocol and randomized to receive ultrasound-guided intraperitoneal 0.9 % saline (US-S) or 0.25 % bupivacaine (US-IPLA) before ovariohysterectomy. On recovery, US-S cats received 2 mg/kg robenacoxib subcutaneously and US-IPLA cats received equivalent volume of 0.9 % saline subcutaneously. Intraoperative outcome variables included heart rate (HR), respiratory rate (fR), systolic arterial pressure (SAP), and vaporizer setting associated with relevant surgical events characterized by manipulation of each ovarian pedicle (OP1, OP2) and the uterine body (UB). The postoperative outcome variable was need for rescue analgesia, determined using the Glasgow Composite Measure Pain Scale during 6 h after tracheal extubation. Intraoperative data were analyzed using two-way ANOVA and Šidák's multiple comparisons test. The probability of postoperative rescue analgesia was analyzed using the Gehan–Breslow–Wilcoxon test. Significance was p < 0.05. ResultsCompared to baseline, all surgical events caused significant increases in HR and SAP in both groups, fR increased in US-IPLA but not in US-S, vaporizer settings remained unchanged during OP1, OP2 and UB in group US-IPLA, and were significantly higher only during OP1 in group US-S. There were no significant between-group differences in intraoperative variables and postoperative need for rescue analgesia. Conclusions and clinical relevancePreoperative intraperitoneal bupivacaine had minimal effects on intraoperative indicators of nociception. The need for rescue analgesia was not significantly different between groups.

Compared the Effectiveness of Intraperitoneal Bupivacaine with Lung Recruitment Maneuver Versus Normal Saline with Lung Recruitment Maneuver in Reducing Shoulder Pain After Laparoscopic Surgery: A Double-Blind Randomized Controlled Trial.

Postoperative shoulder pain is one of the most common complications following laparoscopic surgery. Various interventions have been proposed to control this pain. The main objective of this comparative study was to determine the effects of intraperitoneal bupivacaine and normal saline infusion, in combination with lung recruitment maneuver (LRM), on shoulder pain following laparoscopic surgery. The present randomized controlled trial was conducted on 105 candidates for laparoscopic cholecystectomy referred to Imam Ali Hospital in Bojnurd, Iran, from November 2021 to June 2022. The patients were assigned to three groups using block randomization: BR (receiving 50 cc of 0.25% diluted intraperitoneal bupivacaine + LRM), NR (receiving 50 cc of intraperitoneal normal saline + LRM), and N (receiving 50 cc of intraperitoneal normal saline). Postoperative shoulder pain and surgical incision site pain were assessed using the Visual Analogue Scale (VAS) at recovery intervals of 4, 12, 24, and 48 hours after surgery. Additionally, the prevalence of nausea and vomiting, the first time of need for sedation, and the incidence of sedation overdose in the first 24 hours after surgery were investigated. The data were analyzed using one-way analyzed by one-way analysis of variance (ANOVA) with SPSS software at a significance level of 0.05. The findings showed no significant differences in demographic variables between the three groups. The range and mean score of shoulder pain based on VAS was 0 - 1 (0.3) in the BR group, 0 - 2 (1.4) in the NR group, and 1 - 3 (2.1) in the N group at 4 hours after surgery. The mean score of shoulder pain intensity in the BR group was lower compared to the NR and N groups during recovery time intervals at 4, 12, and 24 hours after surgery. This difference between groups was significant. There was also a statistically significant difference in the mean score of surgical incision site pain intensity and the first time of need for sedation between the three groups. The occurrence of side effects was not significant between the groups. Itching, bradycardia, and hypotension were not observed in any of the groups. The findings of this study showed that bupivacaine, along with LRM, is a safe method effective in relieving postoperative shoulder pain. It prolonged the first time of need for sedation and significantly reduced the incidence of shoulder pain.

A comparative evaluation of intraperitoneal bupivacaine alone and bupivacaine with dexmedetomidine for post-operative analgesia following laparoscopic cholecystectomy.

Intraperitoneal instillation of local anaesthetic agents alone or in combination with opioids, α2 agonists such as Dexmedetomidine have been found to reduce postoperative pain following laparoscopic cholecystectomy. The study was designed to compare the better drug among Bupivacaine alone and Bupivacaine with Dexmedetomidine with respect to their analgesic efficacy and safety profile. in patients undergoing laparoscopic cholecystectomy. The study was carried out on sixty patients of the American Society of Anaesthesiologists (ASA) physical status I-II of either sex with ages ranging from 18 to 60 years posted for elective laparoscopic cholecystectomy under General Anaesthesia, equally divided into two groups, randomly allocated to one of the Groups using the table of randomization. Group B received Intraperitoneal Bupivacaine 40 ml 0.25% +5 ml normal saline and Group BD received Intraperitoneal Bupivacaine 40 ml 0.25% + Dexmedetomidine1 μg/kg diluted in 5 ml Normal saline. The mean heart rate and blood pressure (systolic, diastolic and mean) readings were significantly lower in Group BD than in Group B. The mean duration of analgesia in our study was longer in Group BD (7.5 ± 0.73 hours) when compared to Group B (5.9 ± 0.55 hours) with p-value & 0.0001 and CI 1.27 to 1.9, which was statistically significant. However, the post-operative analgesic requirement (rescue/demand) in Group B was clinically earlier and statistically significant as compared to Group BD. Postoperative VAS score ≥3 was considered the benchmark for providing rescue analgesia in the form of injection of Diclofenac 75 mg IV. In our study, we observed the pain scores via VAS/NRS at 30 min, 1 h, 2 h, 4 h, 6 h, 8 h, 10 h, 12 h, 14 h, 16 h, 18 h, 20 h, 22 h and 24 h postoperatively. A comparison of pain scores from 30 min to 10hrs postoperatively showed a significant difference in both Groups with Group B having significantly higher VAS scores and lower VAS scores with Group BD. Our study suggests that there is a shorter duration of action of 0.25% Bupivacaine alone as compared to 0.25% Bupivacaine + Dexmedetomidine. Since the laparoscope is still inside the abdominal cavity the drugs are easy to administer with no adverse effects and with a good safety profile because of the visualization of drug deposition in the right place. Intraperitoneal instillation of Bupivacaine with Dexmedetomidine for postoperative analgesia was very promising as a part of multimodal analgesia in laparoscopic cholecystectomy.

Effectiveness of Intraperitoneal Bupivacaine in General Anesthesia for Laparoscopic Appendectomy

&lt;p&gt;&lt;strong&gt;Introduction:&lt;/strong&gt; Appendicitis is an inflammation of vermiform appendix organ. It is a medical emergency case and one of the most common acute abdominal cases. The removal of acute appendix with minimally invasive surgery, laparoscopic procedure, is associated with shortened recovery time and length of stay in hospital, reduced risk of postoperative wound infections, also improved cosmetic outcomes. Anesthesia procedure for laparoscopic in Indonesia is usually performed under general anesthesia (GA) which has effective and safe form of sedation. One local anesthesia agent that often used in laparoscopic procedure is bupivacaine. Studies have shown that intraperitoneal bupivacaine as analgesia after laparoscopy can reduce postoperative pain, such as visceral pain associated with tissue injury and the stretching of nerve endings in the peritoneal cavity, parietal pain related to the incisional trauma at the port sites, and shoulder pain referred by stretching of the diaphragm.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Case report: &lt;/strong&gt;Mr. TA, 27 years old, his lower right abdomen hurt and he was diagnosed with acute appendicitis ASA II. Patients performed with laparoscopic procedure under general anesthesia. Fentanyl 2 mcg/kg, propofol 2 mg/kg, rocuronium 0.6 mg/kg, and sevoflurane 1 MAC, 50% FiO&lt;sub&gt;2&lt;/sub&gt; : 50% water, 4 lpm flow were administered. After 90 minutes of surgery, 40 cc of 0.5% intraperitoneal bupivacaine was administered. Patient was assessed for the NRS score within 30 minutes after laparoscopic procedure. The NRS score was 0.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; It has been reported a patient underwent laparoscopic appendicitis procedure received intraperitoneal bupivacaine as a postoperative analgesia which provided quicker recovery and good improvement of pain control without any significant negative consequences.&lt;/p&gt;

A comparative study of the analgesic efficacy of intraperitoneal instillation of diluted bupivacaine versus non-diluted bupivacaine after laparoscopic cholecystectomy, a prospective single-blinded controlled randomized study

ABSTRACT Intraperitoneal (IP) bupivacaine instillation for postoperative analgesia after laparoscopic cholecystectomy (LC) has been reported in many studies as either diluted or non-diluted, with conflicting results and no standard recommendations. Objective Our study aims to compare the analgesic efficacy of intraperitoneal instillation of diluted versus non-diluted bupivacaine after laparoscopic cholecystectomy. Methods In this prospective, single-blinded, controlled and randomized study, we included 50 patients undergoing LC. They were randomly divided into two groups, with 25 patients each. At the end of surgery, the first group received intraperitoneal 20 ml bupivacaine 0.5% (100 mg), added to 480 ml normal saline, diluted bupivacaine group (DBG) and the second group received intraperitoneal 20 ml bupivacaine 0.5% (100 mg); non-diluted bupivacaine group (NBG). Pain was assessed and recorded using the visual analog scale (VAS) for 24 h. Time to the first analgesic request, total analgesic consumption in 24 h, incidence of negative effects after LC, such as nausea, vomiting and shoulder pain, any side effects due to local anesthetic used as hypotension, bradycardia or respiratory depression and hemodynamic parameters were also recorded. Results Postoperative VAS values were significantly lower in DBG than NBG in the 1st 24 h (P value ≤ 0.003). The duration of analgesia (the 1st time analgesic request) was significantly longer in DBG (20.16 ± 3.52 h) than that in NBG (6.19 ± 2.93 h) (P value = 0.0001). Also, the total amount of postoperative analgesic consumption (tramadol) was less in DBG (7.2 ± 19.9 mg) than NBG (63 ± 31.16 mg) (P value = 0.0001). In relation to negative effects after LC, side effects due to analgesic drugs and hemodynamic parameters, the results were comparable in both groups. Conclusion Intraperitoneal instillation of diluted bupivacaine at the end of laparoscopic cholecystectomy decreases postoperative pain, delays request for rescue analgesia and reduces the amount of analgesics in the 1st 24 h postoperatively, more than non-diluted bupivacaine, with comparable results in incidence-negative effects after LC, side effects due to analgesic drugs and comparable hemodynamic parameters.

Ultrasound-Guided Transversus Abdominis Plane Block Versus Intraperitoneal Instillation of Bupivacaine after Laparoscopic Cholecystectomy – A Randomized Control Trial

Background: Postoperative pain prolongs hospital stay after laparoscopic cholecystectomy and remains a major challenge during the postoperative period. Effective pain control encourages early ambulation, which significantly reduces postoperative complications. In recent years, multimodal analgesia has been recommended with fewer adverse effects and more effective analgesia. The primary objective of this study was to compare the efficacy of analgesia between Transversus Abdominis Plane Block (TAP) Block and intraperitoneal instillation of bupivacaine by comparing the meantime of the first dose of rescue analgesia in either group and the total supplementary analgesia required. Methods: This retrospective observational study was conducted on 150 patients who underwent laparoscopic cholecystectomy Group 1 comprised of patients who had received Intraperitoneal Bupivacaine for analgesia and Group 2 received TAP Block for pain relief. Results: Time of the first dose of analgesia after surgery was observed earlier in Group 1 as compared to Group 2 (Time – hours: 9.2 ± 2 vs. 12.3 ± 1.6; p = 0.0001. The Total dose of analgesic was higher in the Intra Peritoneal Bupivacaine Group as compared to the TAP group. Conclusion: AP block provided for a better quality of analgesia as assessed by the reduced requirement of intravenous supplementary analgesia which was less in patients who were given TAP Block as compared to local instillation of Bupivacaine. Keywords: Cholecystectomy, Bupivacaine, Transversus abdominis plane block

Assesment of Postoperative Analgesic Effects of Intramuscular Tramadol Administration and Intraperitoneal Bupivacaine following Laparoscopic Cholecystectomy

Background: For postoperative pain relief after laparoscopic surgeries, intramuscular or intravenous non-steroidal anti-inflammatory drugs and opioids, infiltration at the incision site with local anesthetics, intraperitoneal infiltration of local anesthetics with adjuvants, epidurals and nerve blocks were in use. The study was aimed to assess the efficacy of intramuscular Tramadol and intraperitoneal instillation of bupivacaine on postoperative analgesia, postoperative nausea, and vomiting following laparoscopic cholecystectomy.&#x0D; Methods: This study included 60 American Society of Anesthesiologists (ASA) I and ASA II patients of aged 18-60 years who were scheduled for laparoscopic cholecystectomy under general anesthesia. 60 patients were classified randomly into two groups equally: Group T received 100 Mg of intramuscular tramadol and Group B received intraperitoneal instillation of 30 ml of plain bupivacaine. Time duration, postoperative pain, haemodynamics, nausea, vomiting, and time taken to rescue analgesia were noted.&#x0D; Results: The time for onset of analgesia was 6.51 ± 2.41min in group T and 7.61 ± 2.19 min in group B (p=0.039). The duration of analgesia was 2.37 ± 0.67 hours in group T and 3.65 ± 0.79 hours in group B (p=0.002). VAS Score was significantly lower in Group T than Group B at 1hr, 2hr, 4hr and 6hr (p &lt;0.05). Intraperitoneal bupivacaine showed a significant reduction in postoperative pain for the first 6 hours postoperatively (P&lt;0.05), and time taken to rescue analgesia requirement was prolonged (P&lt;0.05). The rescue analgesia consumption of Paracetamol was 1.5 grams in group-B and 2.5 grams in group T (P&lt;0.05) in 24 hr post-surgery. Nausea and vomiting were observed in 2 cases, and shoulder pain in one case in group T.&#x0D; Conclusion: Bupivacaine is effective in reducing postoperative pain, and it prolongs the requirement time for rescue analgesia after LC surgery. It also required less consumption of rescue analgesic without fluctuations in hemodynamics

Exploring the Gender-Specific Impact of Intraperitoneal Bupivacaine on Early Postoperative Pain in Sleeve Gastrectomy.

Background: Early postoperative pain is a significant problem in bariatric and metabolic surgery. Our study aimed to investigate the potential role of intraperitoneal bupivacaine hydrochloride in pain management in the early postoperative period after bariatric and metabolic surgery. Methods: This double-blind, prospective, randomized, controlled study included 68 individuals who underwent bariatric and metabolic surgery at the Department of Surgery, Istanbul Aydin University Hospital. The study group received 20 mL of 0.5% bupivacaine hydrochloride intraperitoneally at the operative site, and the control group received 20 mL of normal saline. Visual analog scale (VAS) scores of each patient were recorded at 2nd, 4th, and 6th hours postoperatively. Results: Our study found significant differences in VAS scores of patients between study group and control group at 2nd, 4th, and 6th hours postoperatively. Significant differences were found between male and female patients in the control group at 2nd, 4th, and 6th hours postoperatively. Interestingly, no significant difference was found between female patients in the study group and control group at 2nd, 4th, and 6th hours postoperatively. Conclusions: Our study suggests that intraperitoneal administration of bupivacaine hydrochloride is effective in reducing early postoperative pain in male patients. However, no significant difference was found between the study group and the control group in female patients. Our results indicate that there may be a gender-related difference in the response to bupivacaine administration. Further research is needed to confirm these findings and determine the optimal dosing and administration of local anesthetics for postoperative pain management.

Intraperitoneal Bupivacaine in Laparoscopic Cholecystectomy, Efficacy and Feasibility

Abstract Background Laparoscopic Cholecystectomy among the most frequently performed elective daycare surgeries. After laparoscopic cholecystectomy shoulder and abdominal pain causes considerable distress, to determine the efficacy of intraperitoneal bupivacaine instillation on management of early postoperative pain in patient undergoing laparoscopic cholecystectomy. Aim of the Work To determined the efficacy of intraperitoneal bupivacaine instillation on management early postoperative pain in patient with laparoscopic cholecystectomy. Patients and Methods This is a prospective randomized study with sample size of 50 patients underwent elective laparoscopic cholecystectomy. We recruited patients from surgery department at Agouza Hospital. We randomly assigned patients to undergo laparoscopic cholecystectomy with bupivacaine and 25 ml of physiological saline (0.9% normal saline) on liver bed or without bupivacaine. Results Fifty patients finally met our inclusion criteria. In bupivacaine group, mean age was 35 (± 6.6), 64% were females and 36% were males. While in non-bupivacaine group mean age was 37.6 (± 6.6), 68% were females and 32% were males with no statistically significant difference between both groups; age (P value=0.22) and age (P value=0.77), In bupivacaine group there was significant pain reduction compared to non-bupivacaine group in terms of VAS at 2 h (p value=0.04), 12 h (p value=0.02), 24 h (, p value=0.01) and VRS at 2 h (p value&amp;lt;0.01), 12 h (p value&amp;lt;0.01), 24 h (p value&amp;lt;0.01). Hospital stay was lower hospital stay in bupivacaine group 0.94 (± 0.16) than nonbupivacaine group 1.21 (± 0.41) (p value&amp;lt;0.01). Need for additional analgesia was lower in bupivacaine group (P value &amp;lt;0.01). Conclusion Intraperitoneal route for administration of local anaesthetic is a safe and effective approach. Bupivacaine is an effective treatment option to achieve postoperative analgesic, limit the duration of hospital stay and the need for additional analgesia. But it did not significantly lower the incidence of nausea and vomiting.

Intraperitoneal Instillation of Bupivacaine and Hydrocortisone for Postoperative Analgesia in Laparoscopic Cholecystectomy Under Spinal Anaesthesia – A Prospective Randomized Study

Background: Laparoscopic cholecystectomy is a minimally invasive procedure requiring less hospital stay and early mobilization as compared to open procedure. The aim of our study was to compare the efficacy of intraperitoneal instillation of hydrocortisone with bupivacaine for postoperative analgesia in patients undergoing laparoscopic cholecystectomy under spinal anesthesia. Materials and Methods: Sixty patients were enrolled in this prospective randomized study. Patients either received 0.125% bupivacaine (Group B) or 0.125% bupivacaine with 100 mg hydrocortisone (Group H) through intraperitoneal drain at the end of surgery. Pain was evaluated every two hourly using the Visual Analog Scale (VAS) for 24 h. Analgesics were required during this period and the presence of shoulder pain was also noted. Results: Patients in the hydrocortisone group had lower pain scores (2.17 ± 0.47) compared to the bupivacaine group (3.51 ± 1.10). This difference in the mean VAS score was statistically significant (P &lt; 0.01). Similarly, patients requiring rescue analgesia were 60.86% in Group B and 39.14% in Group H and were statistically significant. Time for rescue analgesia was longer in Group H as compared to Group B. Conclusion: Intraperitoneal bupivacaine and hydrocortisone decrease pain and analgesic requirements more effectively than bupivacaine alone after laparoscopic cholecystectomy without causing significant adverse effects.

Randomised, prospective, blinded, clinical trial of opioid-free injectable anaesthesia with or without multimodal analgesia in kittens undergoing ovariohysterectomy.

This study compared an opioid-free injectable anaesthetic protocol with or without multimodal analgesia in kittens undergoing ovariohysterectomy. In this prospective, randomised, blinded, clinical trial, 29 healthy kittens (mean ± SD weight 1.55 ± 0.46 kg; aged 10 weeks to 6 months) were included. Anaesthesia was performed with an intramuscular injection of ketamine (4 mg/kg), dexmedetomidine (40 μg/kg) and midazolam (0.25 mg/kg). In the multimodal group (MMG), cats (n = 14) received meloxicam (0.1 mg/kg SC) and intraperitoneal bupivacaine 0.25% (2 mg/kg), whereas the same volume of saline was administered in the control group (CG; n = 15). Atipamezole (0.4 mg/kg IM) was given 15 mins after ovariohysterectomy. Postoperative pain was assessed using the UNESP-Botucatu multidimensional feline pain assessment scale - short form. Rescue analgesia (buprenorphine 0.02 mg/kg IM in MMG/CG and meloxicam 0.1 mg/kg SC in CG) was administered if pain scores were ⩾4/12. Soft food intake (after 2 and 60 mins) was evaluated at specific time points postoperatively. Statistical analyses were performed with linear models and post-hoc pairwise comparison with Benjamini-Hochberg corrections (P <0.05). The prevalence of rescue analgesia was higher in the CG (n = 15/15) than the MMG (n = 1/14; P <0.001). Pain scores at 1 h, 2 h and 4 h postoperatively were higher in the CG (4.1 ± 2.8, 4.8 ± 3.0 and 5.3 ± 1.2, respectively) than in the MMG (1.6 ± 1.0, 1.1 ± 1.0 and 0.9 ± 0.8, respectively; P <0.001). Food intake (%) at 1 h postoperatively was higher in the MMG after 2 and 60 mins (10.4 ± 9 and 71.9 ± 29, respectively) than in the CG (1.4 ± 2 and 13.9 ± 7, respectively; P <0.001). This opioid-free protocol using multimodal analgesia produced adequate postoperative pain relief, while almost eliminating the need for rescue analgesia in kittens undergoing ovariohysterectomy. Pain decreased food intake.

COMPARISON OF INTRA-PERITONEAL BUPIVACAINE AND INTRAVENOUS PARACETAMOL FOR POSTOPERATIVE PAIN RELIEF AFTER LAPAROSCOPIC CHOLECYSTECTOMY

Introduction: Non-steroidal ant iinammatory drugs (NSAIDs) used for postoperative analgesia have signicant side effects, with paracetamol having a different mechanism of action, a better side effect prole, and intravenous (IV) availability. Aim of the study was to Aims And Objectives: compare intra-peritoneal bupivacaine to intravenous paracetamol for postoperative analgesia after laparoscopic cholecystectomy. Materials And Methods: It is a prospective randomized clinical trial. After ethics committee approval and written informed consent. This study was undertaken in the Government General Hospital, afliated to Siddhartha Medical College ,Vijayawada, Andhra Pradesh. The study included 60 patients with American Society of Anesthesiologists physical status I and II who were scheduled for laparoscopic cholecystectomy. Group I patients were given 2 mg/kg of 0.5% bupivacaine as a local intra-peritoneal application, Group II patients were given IV 1 g paracetamol every 6 hours. Postoperative pain was assessed using the Visual Analog Scale (VAS), Visual Rating Prince Henry Scale (VRS), and shoulder pain. The total number of patients who required rescue analgesia, as well as any side effects, were recorded. The data was analysed using the Students unpaired t-test. P&lt;0.05 was considered statistically signicant. At the 8th, 12th, and 24th postoperativ Results: e hours, the VAS scores in Group I were signicantly higher than in Group II (p=0.001). Although VRS in Group I was higher than VRS in Group II at the 12th and 24th postoperative hours, the difference was statistically signicant only at the 24th postoperative hour 1.53±0.50 vs 1.23±0.43 (p=0.016). Up to 8 hours postoperatively, none of the patients in either group experienced shoulder pain. The total number of patients requiring analgesics was higher in Group II than in Group I. Altho Conclusion: ugh local anaesthetic inltration and intra-peritoneal administration of 0.5% bupivacaine reduce the severity of incisional, visceral, and shoulder pain in the early postoperative period, IV paracetamol provides long-term pain relief after elective laparoscopic cholecystectomy for 24 hours

Intraperitoneal Versus Intravenous Dexmedetomidine for Postoperative Analgesia Following Laparoscopic Sleeve Gastrectomy Surgery: A prospective, Randomized Controlled trial

ABSTRACT Background Postoperative pain control is a major challenge after laparoscopic sleeve gastrectomy. We conducted this study to evaluate the efficacy of dexmedetomidine either intraperitoneal (IP) or intravenous (IV) as an adjuvant to intraperitoneal bupivacaine in patients undergoing sleeve gastrectomy. Methods A total of 105 patients were randomized in this prospective, controlled study. All patients received 40 ml bupivacaine 0.25% IP. Control group (n = 35): received 50 ml normal saline IV. IV dexmedetomidine group (n = 35): received 50 ml normal saline plus dexmedetomidine 1 µg/kg IV. IP dexmedetomidine group (n = 35): received IP dexmedetomidine 1 µg/kg plus bupivacaine 0.25%, and 50 ml normal saline IV. Time to first rescue analgesia was the primary outcome. Whereas the total consumption of tramadol and visual analog scale (VAS) were the secondary outcomes. Results The first time of rescue analgesia was prolonged in IP dexmedetomidine compared to IV dexmedetomidine and control group (P ˂ 0.0001). The total amount of rescue tramadol was lower in IP dexmedetomidine compared to IV dexmedetomidine and control group (P ˂ 0.0001). VAS was comparable between the three groups at the recovery room, 2, 4, and 24 h postoperatively, while a statistically significant difference was found at 6, 12, and 18 h postoperatively. Extubation and recovery times were prolonged in IV dexmedetomidine group (P ˂ 0.0001, 0.0001; respectively). Conclusions IP dexmedetomidine as an adjuvant to IP bupivacaine is as efficacious as IV dexmedetomidine compared to IP bupivacaine alone. However, the IP administration has the longest duration of analgesia and the lowest postoperative analgesic consumption. Clinical trial registration number Clinical Trials.gov (NCT04370392).

Pain Management after Laparoscopic Cholecystectomy by Intraperitoneal Bupivacaine

Aim: To compare the effectiveness of 0.5% bupivacaine spray on the gallbladder at the end of surgery with the effectiveness of no spray in reducing postoperative pain within the first 24 hours. Study design: Randomized Controlled Trial Place and duration: The study was conducted in the Department of General Surge,Combined Military Hospital, Rawalpindi, from 23 July 2018 to 22 January 2019, after receiving approval from the ethics review board. Method: A total of 62 patients underwent laparoscopiccholecystectomy. Indications were symptomatic gallstones (such as dyspepsia, pain in right hypochondrium, and pain after eating fatty meals). The patient age group was between 20-60 years. Patients includedAcutecholecystitis, choledocholithiasis, pancreatitis and bile leakage during surgery. However pregnant females and patients with co-morbidities were not included. Informed consent was taken from all the patients.At the end of the laparoscopic cholecystectomy, Group A infused 0.5% bupivacaine into the gallbladder depression at a standard weight of 2mg/kg, but Group B did not receive a local anaesthetic. Postoperative pain was assessed and scored in both groups from 0 to 10 at 6 and 24 hours using the VAS (Visual Analogue Scale). Result: The mean age of patients in group A was 38.23±8.13 years, and in group B, 38.74±6.64 years. Most of the 35 patients (56.54%) were between 20 and 40 years of age. Among 62 patients, 35(56.54%) were male and 47(75.81%) were female. So the male-to-female ratio is 1:3.2. Efficacy (0.5% bupivacaine) was 22 patients (70.97%) in group A (intervention group) and 11 patients (35.48%) in group B (control group) (p-value = 0.005). Conclusion: The study resulted that the effectiveness of 0.5% bupivacaine spray on the gallbladder at the end of surgery was superior to that of the control group. Keywords: Bupivacaine Spray, LaparoscopicCholecystectomy, Postoperative Pain, VAS (Visual Analogue Scale).

Effect of intra-peritoneal instillation of bupivacaine in laparoscopic cholecystectomy

Background: Laparoscopic cholecystectomy is a minimally invasive surgical procedure for removal of a diseased gall bladder. This technique essentially has replaced the open technique for routine cholecystectomies since the early 1990s. Laparoscopic cholecystectomy has become the gold standard for cholecystectomy in the past decade. Most patients are being discharged on the first or second post-operative day. The aim of the study was to evaluate effect of instillation of intra-peritoneal bupivacaine for pain relief in laparoscopic cholecystectomy. The primary outcome is to evaluate pain scores after this procedure.Methods: It’s an institutional based, observational and randomised control study was conducted in a patients undergoing laparocopic cholecystectomy with gall bladder disease in KPCMCH between 18-70 years of age. The study period was 12 months (from June 2021 to May 2022). 100 patients were included in this study.Results: Our study showed that, less number of patients had right shoulder tip pain (in Numerical rating scale) and requirement of rescue analgesia in case compared to control group.Conclusions: We concluded that instillation of intra-peritoneal bupivacaine reduces pain scores after difficult laparoscopic cholecystectomy.

The evaluation of the analgesic effect of intraperitoneal bupivacaine versus bupivacaine with neostigmine on postoperative pain in laparoscopic cholecystectomy: a randomized controlled double-blinded study

BackgroundThis study aimed to compare the duration of postoperative analgesia using intraperitoneal bupivacaine plus neostigmine or bupivacaine alone. In this randomized controlled trial, we included 56 adult patients scheduled for elective laparoscopic cholecystectomy operation. Patients were randomly allocated into two groups bupivacaine group (B group) who received 50 ml bupivacaine 0.25% alone and bupivacaine-neostigmine group (BN group) who received 500 μg neostigmine added to 50 ml bupivacaine 0.25%. The study drug was instilled intraperitoneal according to group allocation before the start of the surgery. Primary outcome was the duration of analgesia. Other outcome included total dose of postoperative analgesic consumption and postoperative nausea and vomiting.ResultsPatients in BN group showed longer duration of analgesia after surgery and longer time for 1st analgesic dose than the patients in B group. Total dose of postoperative pethidine and the incidence of postoperative nausea and vomiting were lower in number in the BN group than in the B group.ConclusionsIntraperitoneal instillation of neostigmine as an adjunct to bupivacaine in elective laparoscopic cholecystectomy increased the duration of postoperative analgesia. Also, it might reduce postoperative pain and analgesic requirements as compared to bupivacaine 0.25% alone.Trial registrationName of the registry: Clinical trialClinical Trial registration number: NCT04244097Date of registration: 28 January 2020URL of trial registry record: https://clinicaltrials.gov/ct2/show/NCT04244097

A randomized, prospective, masked clinical trial comparing an opioid-free vs. opioid-sparing anesthetic technique in adult cats undergoing ovariohysterectomy.

This study aimed to compare the analgesic effects of an injectable protocol using multimodal analgesia with or without opioids in cats undergoing ovariohysterectomy (OVH). Thirty-two healthy cats were enrolled in a prospective, blinded, randomized trial after the caregiver's written consent. Cats received a combination of ketamine (4 mg/kg), midazolam (0.25 mg/kg) and dexmedetomidine (40 μg/kg), and either buprenorphine (20 μg/kg) or saline (same volume as buprenorphine) intramuscularly [opioid-sparing (OSA) and opioid-free anesthesia (OFA) groups, respectively]. Intraperitoneal bupivacaine 0.25% (2 mg/kg) and meloxicam (0.2 mg/kg subcutaneously) were administered before OVH. Atipamezole (400 μg/kg intramuscularly) was administered at the end of surgery. Pain and sedation were evaluated using the Feline Grimace Scale (FGS) and a dynamic interactive visual analog scale, respectively. Intravenous buprenorphine was administered as rescue analgesia if FGS scores ≥ 0.39/1. Statistical analysis included repeated measures linear mixed models, Fisher's exact test and Bonferroni adjustments when appropriate (p < 0.05). Twenty-seven cats were included. The prevalence of rescue analgesia was lower in OSA (n = 0/13) than in OFA (n = 5/14) (p = 0.04). The FGS scores (least square means and 95% CI) were higher in OFA at 1 [2.0 (1.3-2.7)] and 2 h [2.2 (1.5-2.9)] than baseline [0.7 (0.0-1.4)], but not in OSA. Sedation scores were not significantly different between groups. Opioid-free injectable anesthesia was appropriate for some cats using a multimodal approach. However, a single dose of intramuscular buprenorphine eliminated the need for rescue analgesia and assured adequate pain management after OVH in cats.

Analgesic effect of intravenous versus intraperitoneal dexmedetomidine as an adjuvant to intraperitoneal bupivacaine (0.125%) in laparoscopic cholecystectomy: a randomized, double blind, interventional study

Background and Aims: Laparoscopic cholecystectomy has emerged as a gold standard technique for gall bladder stones. The aim of the present study was to compare the analgesic effect of intravenous (IV) vs intraperitoneal (IP) dexmedetomidine as an adjuvant to intraperitoneal (IP) bupivacaine in laparoscopy. Methods: A prospective, randomized, double blind, interventional study was conducted on 100 patients undergoing laparoscopic cholecystectomy where they were divided into following 2 groups: Group A: Patients received IV 1µg/kg dexmedetomidine diluted to 30 ml with normal saline over 10 min and 40 ml of 0.125% bupivacaine IP after removal of gall bladder. Group B: Patients received IV 30 ml of normal saline and 1µg/kg IP dexmedetomidine in 40 ml of 0.125% IP bupivacaine after removal of gall bladder. The primacy outcome was noted as a difference in mean duration for need of first rescue analgesia. The total consumption of analgesic in first 24hours was recorded and compared between the two groups. Results: Both the groups were comparable in terms of demographic profile and intraoperative hemodynamic parameters with no statistical difference. Comparison of time to first analgesic requirement between the two groups showed statistically significant results with unpaired t test The time of first rescue analgesia in Group A was 151.80 min ± 76.624. and in Group B was 94.80min ± 21.499. The total analgesic requirement in 24 hours in Group A was 136.64 ± 31.251 and in Group B was 144.12 ± 21.49. Conclusion: In our study we concluded that intravenous dexmetomidine provided superior analgesia as compared to intraperitoneal dexmetomidine when used as an adjuvant with Bupivacaine intraperitoneally.

A comparative study of intraperitoneal Bupivacaine with Dexmedetomidine versus intraperitoneal Bupivacaine with Fentanyl for post operative analgesia following laparoscopic cholecystectomy

Abstract INTRODUCTION: Maximum open surgeries are being replaced with laparoscopic surgeries. Laparoscopic cholecystectomy is being more commonly practiced than open surgery. Many parenteral or oral medications are used to control post operative pain following laparoscopic cholecystectomy do have their own side effects. So, local instillation will be beneficial with lesser or negligible side effects. The present study was conducted to compare the effect of intraperitoneal instillation of 0.25% Bupivacaine with Dexmedetomidine and 0.25% Bupivacaine with Fentanyl to know which combination has better efficacy in patients of Laparoscopic Cholecystectomy. METHODOLOGY: The present comparative study was carried on patients posted for Laparoscopic Cholecystectomy in a tertiary care hospital during 2019 to 2022, The patients were divided in two equal groups of 40 each with Group D - Patients receiving 0.25% bupivacaine with Dexmedetomidine and were instilled with 30ml of 0.25% bupivacaine with 1 μg/kg Dexmedetomidine (diluted in 2 ml Normal Saline). Also, Group F - Patients receiving 0.25% bupivacaine with Fentanyl where patients were instilled with 30ml of 0.25% bupivacaine with 1 μg/kg Fentanyl (diluted with 2 ml Normal saline NS). Degree of postoperative pain was assessed using Visual Analogue Scale (VAS). RESULTS: Overall VAS in 24 hrs was significantly lower in the D group compared to F group. The time required for the first dose of rescue analgesia was longer in the D group than in F group, indicating better and longer pain relief in the D group compared to that of F group. The difference was also statistically significant among the two groups. Total analgesic consumption was high in F group than in the D group. CONCLUSION: We concluded that intraperitoneal instillation of dexmedetomidine 1 μg/kg in combination with 0.25% Bupivacaine in elective laparoscopic cholecystectomy significantly reduces the post operative pain and analgesic requirement in postoperative period.

Comparison of Intra-Peritoneal Bupivacaine with Saline Solution after Laparoscopic Cholecystectomy

Objective: To compare the mean pain score of intra-peritoneal bupivacaine versus saline solution in patients undergoing laparoscopic cholecystectomy for cholelithiasis. Material and methods: Between April 2021 to October 2021, total 100 diagnosed patients of cholelithiasis having age 18-70 years, of either gender planned to undergo laparoscopic cholecystectomy under general anesthesia with ASA I-II were selected from Department of Surgery, Mayo Hospital, Lahore. In Bupivacaine group, Intra-peritoneal Bupivacaine was given. In Saline group, Intra-peritoneal Saline Solution was given. Laparoscopic Cholecystectomy was performed. Mean pain score was compared between Bupivacaine group and Saline group. Results: Patients having age 18-70 years were selected. Mean age was 43.80±15.60 years. The mean age of patients in Bupivacaine group was 43.3±16.0 years and in Saline group was 44.3±15.3 years. In Bupivacaine group and Saline group, mean pain score was 1.82±0.75 and 4.72±1.20 respectively. Significantly (P=0.000) low mean pain score was noted in Bupivacaine group as compared to Saline group. Conclusion: There is a significant difference in mean pain score of intra-peritoneal bupivacaine versus saline solution in patients undergoing laparoscopic cholecystectomy for cholelithiasis. Keywords: Cholelithiasis, Cholecystectomy, Intra-peritoneal Bupivacaine, Saline Solution.