Published: 2020-09-23

A prospective observational study: combined irrigation of bupivacaine at the gallbladder fossa with infiltration at port site for postoperative pain relief after laparoscopic cholecystectomy

Palak Paliwal, Tanweerul Huda, Krishnanand Anand, Manish Shivani, Navneet Mishra


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.  



Laparoscopic cholecystectomy, Bupivacaine, Analgesia, Port site infiltration, Gall bladder, fossa infiltration

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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.