DOI: http://dx.doi.org/10.18203/2349-2902.isj20191485

Comparison of intraincisional vs intraperitoneal bupivacaine for the control of postoperative pain after laparoscopic cholecystectomy

Umar Qadir Bacha, Majid Mushtaque, Sifna Tahir

Abstract


 

Background: The aim of this study was to compare the efficacy of infiltration of local anaesthetic bupivacaine at incision site (port site) and intraperitoneally on postoper­ative pain in patients undergoing laparoscopic cholecystectomy.

Methods: This was a randomized controlled study carried out on patients undergoing laparoscopic cholecystectomy. The patients were divided into three groups of 60 patients each. Group 1 was the control group which did not receive either intraincisional or intraperitoneal bupivacaine. Group 2 received intraincisional bupivacaine 0.25% 20 ml, while group 3 received 20 ml solution of bupivacaine 0.25% 20 ml intraperitoneally. Postoperative pain was recorded for 24 hours post-operatively.

Results: The incidence of abdominal pain was significantly lower in the group which received intraincisional bupivacaine upto 12 hours postoperatively. Right shoulder pain was low in group receiving intraperitoneal bupivacaine as compared to group 2, but it was not statistically significant.

Conclusions: Intraincisional (port site) infiltration of bupivacaine is more effective than intraperitoneal infiltration for postoperative pain relief after laparoscopic cholecystectomy. It is easier to apply and there is less requirement of postoperative analgesics.


Keywords


Bupivacaine, Postoperative pain, Laparoscopic cholecystectomy, Intraincisional, intraperitoneal

Full Text:

PDF

References


Gadacz TR, Talamini MA. Traditional versus laparoscopic cholecystectomy. Am J Surg. 1991;161:336–8.

Zacks SL, Sandler RS, Rutledge R, Brown RS. A population-based cohort study comparing laparoscopic cholecystectomy and open cholecystectomy. Am J Gastroenterol. 2002;97:334–40.

Kucuk C, Kadiogullari N, Canoler O, Savli S. A Placebo-controlled comparison of bupivacaine and ropivacaine instillation for preventing postoperative pain after laparoscopic cholecystectomy. Surg Today. 2007;37:396–400.

Joris J, Thiry E, Paris P, Weerts J, Lamy M. Pain after laparoscopic cholecystectomy: Characteristics and effect of intraperitoneal bupivacaine. Anesth Analg. 1995;81:379–84.

Lum YW, House MG, Hayanga AJ, Schweitzer M. Postcholecystectomy syndrome in the laparoscopic era. J Laparoendosc Adv Surg Tech A. 2006;16:482–5.

Wilson YG, Rhodes M, Ahmed R, Daugherty M, Cawthorn SJ, Armstrong CP. Intramuscular diclofenac sodium for postoperative analgesia after laparoscopic cholecystectomy: a rando¬mised, controlled trial: Surg Laparosc Endosc. 1994;4:340-4.

Pasqualucci A, Angelis V, Contardo R, Colò F, Terrosu G, Donini A, et al. Preemptive analgesia: intraperitoneal local anesthetic in laparoscopic cholecystectomy. A randomized, doub¬le-blind, placebo-controlled study. Anesthesiology. 1996;85:11-20.

Erol DD, Yilmaz S, Polat C, Arikan Y. Efficacy of thoracic epidural analgesia for laparoscopic cholecystectomy. Adv Ther. 2008;25:45-52.

Berkenbosch A, Teppemb J, Olivier CN, Dahan A. Influences of morphine on the ventilatory response to isocapnic hypoxia. Anesthesiology. 1997;86:1342-9.

Louizos AA, Hadzilia SJ, Leandros E, Kouroukli IK, Georgiou LG, Bramis JP. Postoperative pain relief after laparoscopic cholecystectomy: A placebo-controlled double blind randomized trial of preincisional infiltration and intraperitoneal instillitation of levobupivacaine 0.25%. Surg Endosc. 2005;19:1503-6.

Moiniche S, Jorgensen H, Wetterslev J, Dahl JB. Local anesthetic infiltration for postoperative pain relief after laparascopy: A qualitative and quantitative systematic review of intraperitoneal, port-site infiltration and mesosalpinx block. Anesth Analg. 2000;90:899.

Labaille T, Mazoit JX, Paqueron X, Franco D, Benhamou D. The clinical efficacy and pharmacokinetics of intraperitoneal ropivacaine for laparoscopic cholecystectomy. Anesth Analg. 2002;94:100–5.

Papagiannopoulou P, Argiriadou H, Georgiou M, Papaziogas B, Sfyra E, Kanakoudis F. Preincisional local infiltration of levobupivacaine vs ropivacaine for pain control after laparoscopic cholecystectomy. Surg Endosc. 2003;17:1961–4.

Paulson J, Mellinger J, Baguley W. The use of intraperitoneal bupivacaine to decrease the length stay in elective laparoscopic cholecystestomy patients. Am Surg. 2003;69:275–8.

Avtan L, Berber E, Avcı C. Laparoskopik cerrahide postoperatif analjezi. Ağrı. 1996;8:22-5.

Bisgaard T, Klarskov B, Kristiansen VB, Callesen T, Schulze S, Kehlet H, et al. Multi-regional local anesthetic infiltration du¬ring laparoscopic cholecystectomy in patients receiving prop¬hylactic multi-modal analgesia: a randomized, double-blinded, placebo-controlled study. Anesth Analg. 1999;89:1017-24.

Ure BM, Troidl H, Spangenberger W, Dietrich A, Lefering R, Neugebauer E. Pain after laparoscopic cholecystectomy. Intensity and localization of pain and analysis of predictors in preoperative symptoms and intraoperative events. Surg Endosc. 1994;8:90-6.

Başgül E, Kaynak Ş, Öcal T, Erçelen Ö, Şahin A. İnsizyon bölgesine bupivakain infiltrasyonunun geniş karın insizyonuna bağlı postoperatif ağrı ve narkotik analjezik gereksinimi üzerine etkisi. Ağrı. 1992;4:32-5.

Alessandri F, Lijoi D, Mistrangelo E, Nicoletti A, Ragni N. Effect of presurgical local infiltration of levobupivacaine in the surgical field on postsurgical wound pain in laparoscopic gynegological surgery. Acta Obstet Gynecol Scand. 2006;85:844-9.

Kandil TS, El Hefnawy E. Shoulder pain following laparos¬copic cholecystectomy: factors affecting the incidence and severity. J Laparoendosc Adv Surg Tech A. 2010;20:677-82.

Papadima A, Lagoudianakis E, Antonakis P, Filis K, Makri I, Markogiannakis H, et al. Repeated intraperitoneal instillation of levobupivacaine for the management of pain after laparoscopic cholecystectomy. Surgery. 2009;146:475–82.

Kim TH, Kang H, Park JS, Chang IT, Park SG. Intraperitoneal ropivacaine instillation for postoperative pain relief after laparoscopic cholecystectomy. J Korean Surg Soc. 2010;79:130–6.

Ahmed BH, Ahmed A, Tan D, Awad ZT, Al-Aali AY, Kilkenny J, 3rd, et al. Post-laparoscopic cholecystectomy pain: Effects of intraperitoneal local anesthetics on pain control-a randomized prospective double-blinded placebo-controlled trial. Am Surg. 2008;74:201–9.

Lepner U, Goroshina J, Samarütel J. Postoperative pain relief after laparoscopic cholecystectomy: A randomized prospective double-blind clinical trial. Scand J Surg. 2003;92:121–4.

Zmora O, Stolik-Dollberg O, Bar-Zakai B, Rosin D, Kuriansky J, Shabtai M, et al. Intraperitoneal bupivacaine does not attenuate pain following laparoscopic cholecystectomy. JSLS. 2000;4:301–4.

Elfberg BA, Sjövall-Mjöberg S. Intraperitoneal bupivacaine does not effectively reduce pain after laparoscopic cholecystectomy: A randomized, placebo-controlled and double-blind study. Surg Laparosc Endosc Percutan Tech. 2000;10:357–9.

Inan A, Sen M, Dener C. Local anesthesia use for laparoscopic cholecystectomy. World J Surg. 2004;28:741–4.

Lee IO, Kim SH, Kong MH, Lee MK, Kim NS, Choi YS, et al. Pain after laparoscopic cholecystectomy: The effect and timing of incisional and intraperitoneal bupivacaine. Can J Anaesth. 2001;48:545–50.

Cantore F, Boni L, Di Giuseppe M, Giavarini L, Rovera F, Dionigi G. Pre-incision local infiltration with levobupivacaine reduces pain and analgesic consumption after laparoscopic cholecystectomy: A new device for day-case procedure. Int J Surg. 2008;6:S89–92.

El-labban GM, Hokkam EN, El-labban MA, Morsy K, Saadl S, Heissam KS. Intraincisional vs intraperitoneal infiltration of local anaesthetic for controlling early post-laparoscopic cholecystectomy pain. J Minimal Access Surg. 2011;7(3):173-7.

Cunniffe MG, McAnena OJ, Dar MA, Calleary J, Flynn N. A prospective randomized trial of intraoperative bupivacaine irrigation for management of shoulder-tip pain following laparoscopy. Am J Surg. 1998;176:258–61.

Elhakim M, Elkott M, Ali NM, Tahoun HM. Intraperitoneal lidocaine for postoperative pain after laparoscopy. Acta Anaesthesiol Scand. 2000;44:280.