Postoperative Analgesia In Laparoscopic Cholecystectomy Research Articles

Haemodynamic Responses Following Lidocaine Infusion on Hypertensive Patient Undergoing Laparoscopic Cholecystectomy

Many pharmacological methods have been evaluated to attenuate the adverse haemodynamic responses resulting from airway manipulation and pneumoperitoneum. Intravenous lidocaine infusion is one of them; bolus dose of intravenous lidocaine is used to reduce haemodynamic changes resulting from intubation and extubation reflex whereas intraoperative infusion of lidocaine has been used for post-operative analgesia in laparoscopic cholecystectomy. This randomized controlled trial was conducted to observe the effectiveness of lidocaine infusion in obtundation of haemodynamic responses on hypertensive patient undergoing laparoscopic cholecystectomy. A total number of 80 patients were enrolled in this study. Patients were allocated into two groups by computer generated random chart according to a 1:1 ratio. The patients of group A were given general anaesthesia with placebo normal saline infusion and the patients of group B were given general anaesthesia with lidocaine infusion (1.5mg/kg). Mean differences of blood pressure (SBP & MAP) and heart rate at different time periods from baseline were compared between two groups. The demographic profiles were almost similar between the groups (p>0.05). In comparison between two groups, heart rate, systolic blood pressure and mean arterial pressure rise from baseline value was more in normal saline group (group A) than lidocaine test group (group B) during peri-intubation, pneumoperitoneum and peri-extubation period. Statistical difference was significant between two groups (p<0.05) in different haemodynamic parameters. Adverse events such as tachycardia premature ventricular contraction (PVC) and hypertension were observed much more in group A, which was higher than that of group B. We observed that administration of lidocaine infusion attenuates haemodynamic responses of hypertensive patient during laparoscopic cholecystectomy. CBMJ 2024 July: vol. 13 no. 02 P: 148-157

Laparoscopy-guided transverse abdominis plane block versus port site infiltration for post-operative pain relief after laparoscopic cholecystectomy.

Post-operative analgesia is an important component of patient satisfaction and early discharge from the hospital. A variety of modalities have been tested and are still evolving. The present study is one such evaluation of a novel technique of laparoscopy-guided transverse abdominis plane (LTAP) block for post-operative analgesia in laparoscopic cholecystectomy. A prospective randomised control trial was conducted to verify the effectiveness of LTAP block over port site local anaesthesia infiltration (PSLAI) for post-operative analgesia in patients undergoing laparoscopic cholecystectomy. This study was done over a period of 18 months in a tertiary hospital. A total of 84 patients were recruited and were divided equally into two groups (LTAP and PSLAI). There was no statistical difference between the two groups with respect to gender distribution, comorbidities, number of gallstones, duration of symptoms and surgery time. The rescue dose of diclofenac requirement was less for the LTAP group in comparison to the PSLAI group. No difference was observed in the pain score at 1st h. However, LTAP proved efficient later in the post-operative course (6 h, 24 h and at discharge). There was significant a difference in the pain scores between the two groups, favouring the LTAP group. Hospital stay in the LTAP group was less in comparison to the PSLAI group. LTAP block is an effective method of post-operative analgesia. It impacts analgesia to the whole anterior abdominal wall for a prolonged period when compared to the PSLAI without adding any extra procedural time.

Effectiveness of ESP Block as Post-Operative Analgesia in Comparison with Opioid Analgesia for Laparoscopic Cholecystectomy

Background: In our country, the role of Erector Spinae Plane Block (ESP) for post-operative analgesia in laparoscopic cholecystectomy has not yet been investigated. As a result, the study was designed to compare the effectiveness of ESP block as post-operative analgesia to opioid analgesia for pain control following Laparoscopic Cholecystectomy. Objectives: The aim of the study was to evaluate the effectiveness of ESP block as post-operative analgesia in comparison with opioid analgesia. Methods: This cross-sectional comparative study was conducted at the department of surgery with collaboration of department of Anaesthesiology in CMH for 6 months of period. Before commencement of the study formal ethical clearance was taken from the Ethical Committee of DGMS Army. Total 60 patients, scheduled for laparoscopic cholecystectomy under general anesthesia were included in this study and randomly divided into two groups (30 patients in each group). total 30 Patients, received both GA and ultrasound guided ESP block were assigned as group E and 30 Patients, received GA and opioid analgesia were in group N. Informed written consent was taken from each subject and ethical measures were followed strictly in whole study. Following data collection, data were analyzed by the SPSS 24. Results: In terms of age, sex, BMI and ASA grading, the two groups had identical demographic features (p>0.05 in all cases). There was no significant difference in pre-operative, post-operative, or recovery room heart rate (p>0.05) or mean arterial pressure (p>0.05). In the recovery room, group E has significantly less pain than group N (3.67±0.802 vs 4.3±0.877; p<0.05). A similar improvement was seen in group E at 6, 12 and 24 hours (p<0.05 in all follow ups). Post-operative analgesic consumption was similarly higher in group N at 1, 12, and 24 hours (p<0.05 in all follow up). Except for nausea, which was more common in group N (p<0.05), complications were similar in both groups. ......

Midpoint Transverse Process to Pleura Block for Postoperative Analgesia in Laparoscopic Cholecystectomy: A Pilot Study and Review of Literature

Abstract Background: Midpoint transverse process to pleura block (MTPB) provides a close anatomical alternative to paravertebral block (PVB). The extent of the drug spread in MTPB and analgesic equivalence of MTPB with PVB and other “paravertebral by proxy” blocks are still under study. Methodology: Ten patients posted for elective laparoscopic cholecystectomy were administered general anesthesia, followed by bilateral ultrasound-guided MTPBs. A total of 20 mL of the drug mixed with iohexol dye solution was injected in each block. Postoperative pain scores were assessed. The spread of drug dye solution under ultrasound and fluoroscopy was studied. Results: Eighty percent of patients had NRS < 3 in the postanesthesia care unit. “Pain score” at 24 h was 2 for three patients and 1 for all other patients. The dye spread under fluoroscopy was observed to extend up to 5–7 levels of cephalad and 5–6 levels of caudad from the point of injection. Sonographic drug spread in the paravertebral space was visualized in 13 out of 20 (65%) blocks. Conclusion: With the results of our study and review of literature, it reflects that MTPB is an effective analgesic adjunct in thoracic surgeries and appears promising in abdominal surgeries as well. In laparoscopic cholecystectomies, its potential role in reducing shoulder pain should be explored further. Currently, it is not possible to recommend MTPB over PVB or erector spinae plane block (ESPB). Yet, it is to acknowledge the presence of the “midpoint transverse process to pleura” area as a definite injection target, which may confer some advantages over PVB and ESPB.

Dexmedetomidine versus Dexamethasone as Adjuvant to Bupivacaine in Ultrasound Guided Transversus Abdomins Plane (TAP) Block for Analgesia in Patients Undergoing Laparoscopic Cholecystectomy Surgery

Abstract Background Ultrasound-guided transversus abdominis plane (TAP) block became a common analgesic method after surgery involving the abdominal wall. Different adjuvants have been used to intensify the quality and the duration of local anesthetics. Aim of the Work to compare dexmedetomidine versus dexamethasone added to bupivacaine as adjuvant to the local anesthetic bupivacaine during Ultrasoundguided transversus abdominis plane (TAP) block for postoperative analgesia in laparoscopic cholecystectomy, characteristics including duration of postoperative analgesia, post-operative pain score and sedation score. Patients and Methods The current study included 40 patients scheduled for elective laparoscopic cholecystectomy surgery were given Ultrasound-guided transversus abdominis plane (TAP) block after induction of general anesthesia. The patients were randomly allocated into two groups. Group (DM): patients received 22 ml of Bupivacaine 0.25 %in 20 ml + 1 ug/kg of dexmedetomidine in 2 ml on both sides. Group (DS): patients received 22 ml of Bupivacaine 0.25 % in 20 ml + 4 mg of dexamethasone in 2 ml on both sides. Results VAS pain score at rest especially 6, 12, 24, 48 hrs is significantly less in dexmedetomidine group than in dexamethasone group. VAS pain score at movement especially 6, 12, 24, 48 hrs is significantly less in dexmedetomidine group than in dexamethasone group. 1st rescue dose of analgesics was delayed up to (19.76±2.51 hrs), in dexmedetomidine group in comparison to (12.92±2.17 hrs) in dexamethasone group. The total dose of paracetamol required by patients in the dexmedetomidine group was (3.18±1.07 gm) compared to (5.33±1.16 gm) in dexamethasone group, indicating longer pain-free period and less requirement of analgesia in the dexmedetomidine group. Therefore, use of dexmedetomidine in TAP block has a beneficial effect in reducing the dose of systemic analgesic requirements. Conclusion co administration of 1 ug/kg of dexmedetomidine vs dexamethasone 4 mg to 0.25 % bupivacaine on both sides by US guided TAP block leaded to significant changes in the form of lower HR at 12, 24, 48 hrs, lower sedation score at 1, 6, 12, 24, 48 hrs and no significant changes in systolic blood pressure, diastolic blood pressure, oxygen saturation and respiratory rate.

Comparison between peripheral nerve stimulator-guided serratus anterior plane block versus transversus abdominis plane block for postoperative analgesia in laparoscopic cholecystectomy under general anaesthesia: A double-blind randomised controlled trial.

Laparoscopic cholecystectomy (LC) is a widely accepted surgical procedure associated with postoperative pain. This study was done to compare peripheral nerve stimulator (PNS)-guided serratus anterior plane block (SAP) and transversus abdominis plane (TAP) block for postoperative analgesia for patients undergoing LC. Following approval from the ethical committee, 70 patients for LC were randomly assigned to Group S: SAP block and Group T: TAP block. The blocks were performed under PNS guidance, and 20 ml of 0.375% ropivacaine was administered. The severity of pain was measured using a visual analogue scale (VAS). The study's primary objective was the evaluation of the postoperative VAS score. The time of the first dose of rescue analgesia and total tramadol consumption for 24 h postoperatively were secondary objectives. All the statistical calculation was done using statistical analyses for Social Sciences for Windows version 23.0 (IBM Corp, NY, USA). Lower VAS score was seen in patients of TAP block at rest as well as movement at 6 h (P = 0.001), 12 h (P = 0.001) and 18 h (P = 0.001) postoperatively compared with SAP. The TAP group showed a significantly increased time of first rescue analgesic compared to the SAP group (7.97 ± 0.51 vs. 5.89 ± 1.45, P = 0.001). Tramadol usage was significantly higher in the SAP group than in the TAP group (128.9 ± 36.22 vs. 72.43 ± 44.80, P = 0.001). TAP block guided by the PNS improves postoperative pain with less tramadol consumption and during the postoperative period without significant complications.

A comparative evaluation of intraperitoneal instillation and periportal infiltration of 0.375% ropivacaine with dexmedetomidine and nalbuphine as adjuvants for post-operative analgesia in laparoscopic cholecystectomy

Background: Intraperitoneal instillation (IPI) of local anesthetic agents into peritoneal cavity has proved to be an effective method of post-operative analgesia in laparoscopic cholecystectomy (LC). The addition of adjuvants such as narcotics or α2-agonists has been proposed to prolong the duration of post-operative analgesia. Aims and Objectives: This study aimed to compare post-operative analgesia of IPI and periportal infiltration of ropivacaine plus dexmedetomidine with ropivacaine plus nalbuphine in patients undergoing LC. Materials and Methods: This was a comparative, prospective, randomized controlled double-blind study conducted on total of 100 patients (American Society of Anesthesiologists class I and II) planned for LC who were randomly divided into two groups of 50 patients: Group Ropivacaine+Dexmedetomidine (RD) received IPI and periportal infiltration of 150 mg of ropivacaine (0.375%) and dexmedetomidine (1 μg/kg) diluted with normal saline to 40 mL and Group Ropivacaine+Nalbuphine (RN) received 150 mg of ropivacaine (0.375%) and 10 mg nalbuphine diluted with normal saline to 40 mL. Post-operative pain was assessed by Visual Analogue Score, time to first request of analgesia, and total amount of rescue analgesics given in 24 h and side effects were noted. Data were analyzed by Student’s independent t-test and Chi-square test using SPSS version 20.0. Results: Overall Visual Analog Scale scores (1.38±0.78 vs. 2.59±1.15), time to first request of analgesia (7.3±3.74 vs. 4.2±2.71), and total analgesic consumption (82.4±15.34 vs. 158.5±16.19) were significantly lower in the RD group compared to the RN group. Among post-operative adverse events, the incidence of post-operative nausea and vomiting was significantly higher in the RN group. Conclusion: The addition of dexmedetomidine appears to be superior to nalbuphine in terms of prolonged post-operative analgesia, lesser requirement of rescue analgesia, and less complications.

Comparative study between ultrasound-guided subcostal transversus abdominis plane block and paravertebral block for postoperative analgesia in laparoscopic cholecystectomy

Abstract Background Adequate perioperative analgesia in laparoscopic cholecystectomy (LC) is important for improving patient outcomes. The subcostal transversus abdominis plane (STAP) block and the thoracic paravertebral block (PVB) are types of regional anesthesia that have been used for postoperative analgesia in upper abdominal surgery. Aim The aim was to compare the analgesic efficiency and safety of STAP block versus PVB for postoperative analgesia in LC. Patients and methods This randomized double-blind study was done on 90 patients, of both sexes, from 18 to 65 years old, with American Society of Anesthesiologists I and II, and scheduled for elective LC. Patients were randomized into three equal groups (n=30): group I received general anesthesia (GA) only, group II received GA and preoperative bilateral ultrasound (US)-guided STAP block, and group III received GA and preoperative bilateral US-guided PVB at T7. Results Heart rate, mean arterial blood pressure, and visual analog scale during rest and during cough showed insignificant differences at 30 min, 12, 18, and 24 h after recovery but were significantly lower at 2, 4, and 6 h in STAP and PVB groups compared with the GA group. Meanwhile, there were insignificant differences between STAP and PVB groups during the whole postoperative period. Moreover, the first request of pethidine was significantly longer and the amount of intraoperative fentanyl and postoperative pethidine were significantly lower in STAP and PVB groups than in the GA group. Conclusion Bilateral US-guided STAP block and bilateral US-guided PVB are effective and safe analgesic techniques for LC, but pneumothorax should be considered while performing PVB.

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 < 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.

A Comparison between the Efficacy of Paracetamol Plus Pethidine and Pethidine Alone for Postoperative Analgesia in Laparoscopic Cholecystectomy

A Comparison between the Efficacy of Paracetamol Plus Pethidine and Pethidine Alone for Postoperative Analgesia in Laparoscopic Cholecystectomy

A COMPARATIVE STUDY OF EFFECTIVENESS OF INTRAPERITONEAL INSTILLATION OF BUPIVACAINE IN LAPAROSCOPIC CHOLECYSTECTOMY WITH AND WITHOUT ITS INSTILLATION IN POST-OPERATIVE PAIN MANAGEMENT

Introduction: Laparoscopic cholecystectomy is a gold standard surgical procedure in post-operative pain recovery time. Though it is associated with lesser post-op pain than open cholecystectomy, few patients still experience pain. Pain relief is an important goal of any surgery. Administration of local anaesthetic either during surgery is a method of reducing post-op pain. To Compare the effect of intraperitoneal Aim: instillation of 0.5% bupivacaine with adrenaline and without intraperitoneal instillation of 0.5% bupivacaine with adrenaline for post-operative analgesia in laparoscopic cholecystectomy. A total of 120 participants we Materials & Methods: re considered for this study with 60 participant receiving bupivacaine and other 60 receiving normal saline. VAS/VRS score is measured at 2, 4, 6, 12 & 24 hours after surgery for each group. Results: From the results, we found signicant differences in the mean scores of study group and placebo group. The patients who were given bupivacaine were found to have reduced pain. Conclusion: In our study, we found that bupivacaine reduces postoperative pain. We conclude that the intraperitoneal instillation of bupivacaine is a safe and effective method for providing postoperative analgesia without signicant side effects.

Analgesic Effects of Ropivacaine Combined With Dexmedetomidine in Transversus Abdominis Plane Block in Patients Undergoing Laparoscopic Cholecystectomy: A Systematic Review and Meta-Analysis

This review aimed to conduct a meta-analysis of published randomized controlled studies (RCTs) comparing the effectiveness of dexmedetomidine (DEX) combined with ropivacaine versus single ropivacaine in transversus abdominis plane block (TAPB) for postoperative analgesia after laparoscopic cholecystectomy (LC). The purpose was to investigate whether DEX combined with ropivacaine in TAPB for postoperative analgesia in LC is superior to single ropivacaine administration. A Systematic Review and Meta-analysis. Five electronic database systems were searched for RCTs on the effects of DEX combined with ropivacaine (joint group) and single ropivacaine on postoperative analgesia in LC. The standardized mean difference (SMD) or odds ratio (OR) and their corresponding 95% confidence interval (CI) of the indicators were calculated for comparison. As of December 23, 2021, 153 articles were retrieved, but only 16 articles were finally included in this meta-analysis. The results showed that compared with single ropivacaine, DEX combined with ropivacaine in TAPB had better analgesia and lighter sedative effect in patients after LC. After LC 2h(T1), 4h(T2), 8h(T3), 12h(T4) and 24h (T5), the joint group participants have lower VAS scores (T1: SMD=-0.32, 95%CI: -0.49, -0.14; T2: SMD=-1.11, 95%CI: -1.56, -0.65; T3: SMD=-2.88, 95%CI: -3.74, -2.02; T4: SMD=-2.56, 95%CI: -3.04, -2.08; T5: SMD=-1.44, 95%CI: -1.81, -1.06). Also, the Ramsay score of the joint group is higher than the single group (T1: SMD=1.05, 95%CI: 0.39, 1.71; T2: SMD=1.57, 95%CI: 0.57, 2.57; T3: SMD=1.64, 95%CI: 0.65, 2.63; T4: SMD=1.72, 95%CI: 0.54, 2.89; T5: SMD=0.57, 95%CI: 0.21, 0.94). The results of this review and meta-analysis suggest that DEX combined with ropivacaine has less postoperative pain, more patients got the status of sober and cooperative, and longer postoperative analgesia lasted than ropivacaine alone in TAPB, especially in the group of combined treatment with 1.0 mcg/kg DEX. Furthermore, the flow dynamics of the two groups are stable, and there is no notable difference in the incidence of adverse reactions.

Impact of Peroperative Intravenous Lidocaine on Postoperative Analgesia in Laparoscopic Cholecystectomy

The present study was undertaken to evaluate the outcome of peroperative intravenous lidocaine in reducing the intensity of postoperative pain after laparoscopic cholecystectomy.This prospective randomized clinical trial study was conducted in the Department of Anaesthesiology, Sir Salimullah Medical College Mitford Hospital (SSMC MH), Dhaka between April 2014 to September 2014. A total of 80 patients of chronic cholecystitis or cholelithiasis undergoing laparoscopic cholecystectomy in SSMC MH, Dhaka were consecutively included in the study and were randomly assigned to two study groups. Patients in the study group received I/V lidocaine administration @ 3 mg/kg/h and those in the control group received normal saline (0.9% saline) in the same volume by a different observer. When compared the changes in haemodynamic variables from baseline to endpoint of the study shows that there was no significant difference between the groups in terms of heart rate, systolic, diastolic and mean blood pressures except a sudden rise of the parameters at 5 minutes after induction. However, the systolic blood pressure of study group experienced a slight reduction from 30 minutes onwards to the end of the observation and differed significantly from the corresponding SBPs of the control group. The mean BP of both the groups also showed similar trend like systolic BPs.The SpO2 in both study and control groups was maintained at 99 to 100% throughout the study. The study concluded that peroperative infusion of nontoxic dose of lidocaine decreases the intensity of postoperative pain and reduces the postoperative analgesics(inj. Pethidine) requirement without causing any significant adverse effects. Sir Salimullah Med Coll J 2022; 30: 148-154

Is Right Unilateral Transversus Abdominis Plane (TAP) Block Successful in Postoperative Analgesia in Laparoscopic Cholecystectomy?

Background Transversus abdominis plane (TAP) block is used for postoperative analgesia in laparoscopic cholecystectomy. In laparoscopic cholecystectomy, the incisions are located mainly on the upper right side of the abdomen. Aims We aim to determine the efficacy of less-invasive ultrasound-guided right unilateral oblique subcostal TAP block in laparoscopic cholecystectomy on postoperative analgesia by comparing patients undergoing bilateral TAP block and a control group. Methods Ninety patients were equally divided into control, unilateral, and bilateral TAP block groups. TAP blocks were conducted before anesthesia. No block was applied to the control group. Patients' demographics and postoperative pain, satisfaction, and nausea-vomiting scores and tramadol/ondansetron doses were evaluated. Results There was no significant difference in the verbal numerical rating scale for pain scores at rest and during coughing (VNRS-R and VNRS-C) between unilateral and bilateral TAP block groups at postoperative 1 hour, 2 hour, 4 hour, 8 hour, 12 hour, and 24 hours. In addition, VNRS-R and VNRS-C scores were significantly higher in the control group than in the other two groups. Tramadol consumption in the control group was significantly higher than in the unilateral and bilateral TAP block groups (p ≤ 0.01), while no significant difference was identified between unilateral and bilateral TAP block groups (p=0.303). Nausea-vomiting scores and ondansetron consumption did not differ significantly between all the groups. Patient satisfaction was significantly higher in unilateral and bilateral groups (p < 0.01, p < 0.01) than in the control group, while there was no significant difference between unilateral and bilateral TAP block groups (p=0.793). Conclusions Right unilateral TAP block provides postoperative analgesia as effective as bilateral TAP block in laparoscopic cholecystectomy.

To compare the effect of intraperitoneal instillation of ropivacaine 0.75% 10ml, and ropivacaine with dexmedetomidine 1mcg/kg for post-operative analgesia after laparoscopic cholecystectomy

Background: To compare the effect of intraperitoneal instillation of ropivacaine 0.75% 10 ml, and ropivacaine with dexmedetomidine 1mcg/kg for post-operative analgesia after laparoscopic cholecystectomyMaterials and Methods: This is a prospective, randomised study conducted out on 100 patients of either sex, aged 18-60 years, ASA grade I and II scheduled for laparoscopic cholecystectomy.Results: Intra-peritoneal instillation of 0.75%ropivacaine with dexmedetomidine provides superior and prolonged pain relief without any adverse effects, making its use simple, safe and effective for postoperative analgesia in laparoscopic cholecystectomy. All the results were significant statistically and have correlated well with the studies in reference.Conclusion: we concluded that dexmedetomidine 1µg/kg can be used as adjuvant to 0.75% ropivacaine for effective post-operative analgesia in laparoscopic cholecystectomy. Intra-peritoneal instillation of 0.75%ropivacaine with dexmedetomidine provides superior and prolonged pain relief without any adverse effects, making its use simple, safe and effective for postoperative analgesia in laparoscopic cholecystectomy. Hence, we concluded that use of dexmedetomidine as additive to ropivacaine for intra-peritoneal instillation and port site infiltration in patients posted for elective laparoscopic cholecystectomy, as it significantly prolongs duration of analgesia along with minimal side effects as compared to infiltration with ropivacaine alone.

A comparative study to evaluate the efficacy of intraperitoneal instillation of 0.25% levobupivacaine with or without clonidine (0.75 μg/kg) for postoperative analgesia in patients undergoing laparoscopic cholecystectomy

Background: In recent years, the use of intraperitoneal instillation of local anesthetics with adjuvants has become popular for postoperative analgesia in laparoscopic cholecystectomy. This study aimed to compare the analgesic efficacy and safety of levobupivacaine alone or with clonidine as an adjuvant given through intraperitoneal instillation in laparoscopic cholecystectomy under general anesthesia.Material and Methods: In this prospective randomized double-blind study, 100 patients, aged 18–60 years belonging to ASA physical status I or II, were randomly allocated into two groups. Group L (n = 50) received 0.25% levobupivacaine 28 ml + 2 ml normal saline, whereas Group LC (n = 50) received 0.25% levobupivacaine 28 ml + clonidine 0.75 μg/kg (diluted in 2 ml normal saline) as intraperitoneal instillation before removing trocar. The duration of analgesia, pain scores, total number of doses, and amount of rescue analgesic consumed in 24 h, sedation score, hemodynamics, and adverse effects was noted.Results: Duration of analgesia was significantly prolonged in Group LC (744.10 ± 96.72 min) compared to Group L (525.20 ± 67.91 min) (P < 0.05). Pain scores (VAS) were significantly lower in Group LC (P < 0.05). The total number of doses and amount of rescue analgesic consumption in 24 hours were less in Group LC as compared to Group L (P < 0.05). Sedation, hemodynamics, and side effect profile were comparable in two groups (P > 0.05).Conclusion: Clonidine (0.75 μg/kg) was found to be a safe and effective adjuvant to 0.25% levobupivacaine for intraperitoneal instillation in laparoscopic cholecystectomy in terms of prolonged postoperative analgesia, lower pain scores, reduced rescue analgesic consumption along with no significant sedation, hemodynamic changes, and adverse effects.

COMPARATIVE STUDY OF POST OPERATIVE PAIN RELIEF IN LAPAROSCOPIC CHOLECYSTECTOMY WITH PORT SITE AND INTRAPERITONEAL INSTILLATION OF 0.5% BUPIVACAINE WITH ADRENALINE AND PLACEBO

Introduction : Postoperative pain is variable in intensity,character,duration and is the main factor delaying discharge of patients undergoing day-care procedures including laparoscopy and hence adding to hospital cost and stay. Optimal management has a potential for shortening of hospital stay and for speeding up of recovery.AIM :Comparing the effect of port site and intraperitoneal instillation of 0.5% bupivacaine with adrenaline versus saline for post-operative analgesia in laparoscopic cholecystectomy. To assess the need of rescue analgesics in post- operative period in both groups.Material &amp; Method :A comparative study to be performed on 50 cases receive 40 mls of 0.5% bupivacaine as intraperitoneal infiltration and local infiltration of 20 mls of 0.5% bupivacaine in the port sites (5 ml infiltration in each port) versus 50 cases receive 40 ml of normal saline intraperitoneally Discussion :Reduction in post-operative pain with better cosmesis and early return to work have been the goals to improve cost effectiveness and patient satisfaction. Conclusion : We conclude that instillation of local anaesthetic drug intraperitonialy &amp; Port site local anaesthetic agent injection has added benefits in post operative pain

Comparison of Ultrasound-Guided Modified BRILMA Block with Subcostal Transversus Abdominis Plane Block for Postoperative Analgesia in Laparoscopic Cholecystectomy - A Randomized Controlled Trial.

Background and AimsSubcostal Transversus Abdominis Plane (TAP) block is the standard practice for postoperative analgesia following laparoscopic cholecystectomy. This study aimed to compare the efficacy of modified BRILMA Block (blocking the BRanches of Intercostal nerves at the Level of Mid-Axillary line) with Subcostal TAP block for pain relief following laparoscopic cholecystectomy.MethodsSixty cases scheduled for laparoscopic cholecystectomy were randomly divided into two groups: modified BRILMA block (Group B) and Subcostal TAP block (Group T). General anesthesia was standardized for both groups. Blocks were performed with 20 mL of 0.2% Ropivacaine under ultrasound guidance after induction of anesthesia. Patients were administered morphine through patient controlled analgesia (PCA) pump with a bolus dose of 1 mg, 10 min lockout interval, and a basal infusion rate of 0.1 mg/h. The pain was assessed by the Visual Analog Scale (VAS) scores of one to ten. The total morphine consumption, time to first request for rescue analgesia, and VAS scores at rest and with movement, and complications, if any, were recorded.ResultsThe morphine consumption in Group B was 5.67 ± 1.98 mg and in Group T was 5.17 ± 1.85 mg, which was found to be statistically insignificant (p-value = 0.317). The time to first request for rescue analgesia was 759.33 ± 80.29 min in Group B which was comparable to 854 ± 93.01 min in Group T and statistically insignificant (p-value = 0.295). The average VAS scores at rest as well as on movement were comparable in both the groups during the entire 24 h postoperative period. No complications were encountered in our study.ConclusionUltrasound-guided modified BRILMA block is equally efficacious as subcostal TAP block in providing postoperative analgesia with similar morphine consumption and no significant difference in VAS scores at rest and movement following laparoscopic cholecystectomy.Trial Registration NumberCTRI/2020/02/023457.

Bilateral versus unilateral erector spinae plane block for postoperative analgesia in laparoscopic cholecystectomy: a randomized controlled study

IntroductionLaparoscopic cholecystectomy (LC) is the common surgical intervention for benign biliary diseases. Postoperative pain after LC remains as an important problem, with two components: somatic and visceral. Trocar entry incisions lead to somatic pain, while peritoneal distension with diaphragm irritation leads to visceral pain. Following its description by Forero et al., the erector spinae plane (ESP) block acquired considerable popularity among clinicians. This led to the use of ESP block for postoperative pain management for various operations. Materials and methodsThis study was conducted between January and June 2019. Patients aged between 18 and 65 years with an American Society of Anesthesiologists (ASA) physical status I.ÇôII, scheduled for elective laparoscopic cholecystectomy were included in the study. All the patients received bilateral or unilateral ESP block at the T8 level preoperatively according to their groups. ResultsThere was no significant difference between the groups in terms NRS scores either at rest or while coughing at any time interval except for postoperative 6th hour (p = 0.023). Morphine consumption was similar between the groups but was significantly lower in group B at 12 and 24 hours (p = 0.044 and p = 0.022, respectively). Twelve patients in group A and three patients in group B had shoulder pain and this difference was statistically significant (p = 0.011). DiscussionIn conclusion, bilateral ESP block provided more effective analgesia than unilateral ESP block in patients undergoing elective LC. Bilateral ESP block reduced the amount of opioid consumption and the incidence of postoperative shoulder pain.

Effect of perioperative intravenous lignocaine infusion on postoperative pain in laparoscopic cholecystectomy

Background and Aims: Postoperative pain delays recovery after laparoscopic cholecystectomy which is done as a daycare surgery. Opioid analgesia carries adverse effects like nausea, vomiting and respiratory depression which can affect postoperative recovery. Our aim was to compare lignocaine infusion with saline infusion as perioperative ERAS measure for postoperative analgesia in laparoscopic cholecystectomy. Method: After obtaining ethical clearance, 40 patients undergoing laparoscopic cholecystectomy were randomised by computer generated codes in to two groups A and B. In group B two subjects were moved out of study, so two in group A were also excluded to make the two groups equal. Group A received saline and group B received 2mg/kg/h lignocaine infusion intravenously which were stopped at the end of the surgery. Postoperative pain was assessed by NRS score at definite time intervals 0 (admission to postoperative anesthesia care unit), 2nd, 4th, 6th, 8th, 10th, 12th and 24th hours. Time at which first rescue analgesia was requested, total analgesic requirements, mean NRS score and side effects were noted. Results: At every time interval, patients in lignocaine group had delayed time to request for rescue analgesia, less analgesic requirements and mean NRS. (P value &lt;0.05). No side effects or signs of toxicity were noted in lignocaine group. Conclusion: Perioperative lignocaine infusion is an efficient, safe and cost-effective armamentarium in implementing ERAS in laparoscopic cholecystectomy.