A Comparative Study on the Postoperative Analgesic Effects of the Intraperitoneal Instillation of Bupivacaine Versus Normal Saline Following Laparoscopic Cholecystectomy

Abstract

BackgroundLaparoscopic cholecystectomy is widely performed, and postoperative pain is an important factor in patient morbidity during recovery. Various modalities for postoperative pain relief have been proposed, with varying levels of success such as intravenous or intramuscular non-steroidal anti-inflammatory drugs (NSAIDs) and opioids, infiltration at the incision site with local anesthetics, intraperitoneal infiltration of local anesthetics, intraperitoneal infiltration of local anesthetics with adjuvants, regional anesthesia techniques such as epidurals and nerve blocks. The study was aimed to evaluate the efficacy of intraperitoneal instillation of bupivacaine and normal saline on postoperative analgesia, postoperative nausea, and vomiting after laparoscopic cholecystectomy. MethodsThis prospective, controlled, and randomized study included 60 American Society of Anesthesiologists (ASA) I and ASA II patients, aged 18-50 years, who were scheduled for laparoscopic cholecystectomy under general anesthesia. The patients were classified randomly into two groups with an equal number of participants: Group B received intraperitoneal instillation of 30 ml of plain bupivacaine 0.5% and Group N received 30 ml of normal saline. Postoperative pain was recorded using the visual analog scale (VAS) for 24 hours after surgery. Postoperative shoulder pain, nausea, vomiting, and the time taken to request rescue analgesia were noted. ResultsPatients receiving intraperitoneal bupivacaine showed a significant reduction in postoperative pain for the first six hours postoperatively (P = 0.04); moreover, the time taken to request rescue analgesia requirement was prolonged (P = 0.04). Side effects, such as nausea and vomiting, were similar between the two groups (P = 0.1 and p = 0.09, respectively) while shoulder pain was significantly lower in the bupivacaine group (P = 0.04). ConclusionBupivacaine is effective in reducing postoperative pain, and it prolongs the requirement time for rescue analgesia. It also reduces the incidence of shoulder pain but does not decrease postoperative nausea and vomiting.

The evaluation of feasibility of ambulatory laparoscopic cholecystectomy using intraoperative instillation of bupivacaine: a retrospective observational study

“…Patients who were administered bupivacaine at port sites experienced lower postoperative pain and required fewer analgesic medications [ 6 ]. Several other studies have reported similar results indicating that intraperitoneal instillation reduced postoperative pain effectively [ 7 8 9 ].…”

“…In this study, NRS at 2, 4, and 10 hours were 3.3, 2.4, and 2.2. This is quite astonishing because, in many previous studies, the usual pain scale several hours after LC was about 6 to 9 without intraoperative manipulation of pain control, and with that pain level patients are usually not discharged for OPS [ 6 7 ]. NRS of the OPS group in this study was 4.5, 4.1, and 3.7 at 3, 6, and 9 hours postoperatively.…”

Comparison of intraperitoneal instillation of Bupivacaine vs Normal Saline for postoperative pain relief after laparoscopic cholecystectomy.

“…One of the main goals of intraperitoneal bupivacaine injection is to increase the drug's plasma concentration because of the peritoneum's better ability for systemic absorption. Vijayaraghavalu S. et al 23 reported an increase in plasma concentration of bupivacaine beyond the threshold value of 2mg/L following intraperitoneal administration of 50ml of 0.25% bupivacaine during laparoscopic cholecystectomy. Although substantial respiratory function decline and recurrent hypoxemia episodes (SpO92%) were found in these patients during the postoperative period, this was not the main issue.…”

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

“…2,3 Following laparoscopic cholecystectomy, pain radiates from the incision site to visceral regions, 4 and shoulder tip (sub-diaphragmatic region). 5 For postoperative pain relief, various methods such as intravenous or intramuscular NSAIDs 6 and opioids, 7 infiltration at the incision site with local anaesthetics [8], intraperitoneal infiltration of local anaesthetics, 8 local anaesthetics with adjuvants, 9 and regional anaesthesia techniques such as epidurals and nerve blocks are used. All of these have varying success rates.…”