A prospective observational study: combined irrigation of bupivacaine at the gallbladder fossa with infiltration at port site for postoperative pain relief after laparoscopic cholecystectomy
DOI:
https://doi.org/10.18203/2349-2902.isj20204133Keywords:
Laparoscopic cholecystectomy, Bupivacaine, Analgesia, Port site infiltration, Gall bladder, fossa infiltrationAbstract
Background: Laparoscopic cholecystectomy is a well-established procedure for gallbladder disease. Pain in laparoscopic cholecystectomy is associated with multiple factors: somatic, visceral, and phrenic nerve irritation. Effective analgesic support should, therefore, be a multimodal approach following laparoscopic surgery for better patient compliance.
Methods: A prospective, randomized observational study was undertaken at a tertiary research center for a period of two years (2018-2020). 160 patients undergoing laparoscopic cholecystectomy were chosen and randomized using a computer program into 2 groups. No infiltration was given in the control population. The study group was irrigated with a 0.5% bupivacaine solution (20cc in 30 ml normal saline).
Results: The bupivacaine group required fewer analgesics in comparison to the control faction, with less pain at 6 hrs. The timing of oral intake and ambulation were comparable in both factions.
Conclusions: Combined bupivacaine use led to a considerable decrease in postoperative pain thereby leading to decreased analgesic use.
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References
Gupta V, Jain G. Safe laparoscopic cholecystectomy: Adoption of universal culture of safety in cholecystectomy. World J Gastrointest Surg. 2019;11(2):62-84.
Gupta RS, Rai A, Vasuniya V, Choudhary D. Comparative evaluation of subcutaneous infiltration (port site) vs intraperitoneal infiltration of bupivacaine on post laparoscopic cholecystectomy pain. Int J Surg. 2018;5(2):500-6.
Sarkar S, Rastogi A, Haldar R, Kumar A, Singh S. An audit to study pain after laparoscopic cholecystectomy with the use of nonopioid analgesics. Ind J Pain. 2017;31:170-4.
Tiryaki C, Bayhan Z, Kargi E, Alponat A. Ambulatory laparoscopic cholecystectomy: A single center experience. J Minim Access Surg. 2016;12(1):47-53.
Elvir-Lazo OL, White PF. Postoperative pain management after ambulatory surgery: role of multimodal analgesia. Anesthesiol Clin. 2010;28:217-24.
Barazanchi AH, MacFater WS, Rahiri J-L, Tutone S, Hill A. G, Joshi GP. Evidence-based management of pain after laparoscopic cholecystectomy: a prospect review update. Brtsh J Anaesth. 2018:121(4):787-803.
Pandove P, Arora N, Garg A, Pandove L, Kumar A. Intraperitoneal instillation of bupivacaine in gallbladder fossa and at trocar sites in reduction of postoperative pain after laparoscopic cholecystectomy: a prospective randomized controlled double-blind trial. Int J Surg. 2017; 4(4):1204-08.
Singh R, Bansal D, Singh M, Shah A. Randomized controlled study of effectiveness and timings of bupivacaine at port site in managing pain after laparoscopic cholecystectomy. Int J Surg. 2016;3(4):1837-43.
Bisgaard T, Kehlet H, Rosenberg J. Pain and convalescence after laparoscopic cholecystectomy. Eur J Surg. 2001;167(2):84-96.
Ahmed BH, Ahmed A, Tan D, Awad ZT, Al-Aali AY, Kilkenny J, et al. Post-laparoscopic cholecystectomy pain: effects of intraperitoneal local anesthetics on pain control—a randomized prospective double-blinded placebo-controlled trial. Amrcn Surgeon. 2008;74(3):201-9.
Møiniche S, Jørgensen H, Wetterslev J, Dahl JB. Local anesthetic infiltration for postoperative pain relief after laparoscopy: a qualitative and quantitative systematic review of intraperitoneal, port-site infiltration and mesosalpinx block. Anesth Analg. 2000;90(4):899-912.