Comparison of Intraabdominal and Trocar Site Local Anaesthetic Infiltration on Postoperative Analgesia After Laparoscopic Cholecystectomy

Altuntaş, Gülsüm; Akkaya, Taylan; Özkan, Derya; Sayın, Mehmet Murat; Balas, Şener; Özlü, Elif

doi:10.5152/tjar.2016.75983

Cited by 18 publications

(22 citation statements)

References 20 publications

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“…Few recent studies also not analysed the effects of improved pain relief on attaining early discharge criteria or resumption of daily routine activity. [ 8 9 10 ]…”

Section: Discussionmentioning

confidence: 99%

“…A Turkish study demonstrated that, trocar site local anaesthetic infiltration is more effective then IPLA instillation for postoperative analgesia and reduction in incidence of shoulder pain. [ 8 ] The authors explained that, higher incidence of shoulder pain in IPLA group could be because of dilution of IPLAI with placement of a routine drain to observe potential bile leakages. The incidence of shoulder tip pain in our study is around 7–21% with IPLAI and very similar to the Turkish study (20%).…”

Section: Discussionmentioning

confidence: 99%

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A comparative evaluation of pre-emptive versus post-surgery intraperitoneal local anaesthetic instillation for postoperative pain relief after laparoscopic cholecystectomy: A prospective, randomised, double blind and placebo controlled study

et al. 2019

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Background and Aims:Intraperitoneal local anaesthetic instillation (IPLAI) reduces postoperative pain and analgesic consumption effectively but the timing of instillation remains debatable. This study aims at comparing pre-emptive versus post-surgery IPLA in controlling postoperative pain after elective laparoscopic cholecystectomy.Methods:Ninety patients belonging to American Society of Anesthesiologists physical status I or II were randomly assigned to receive IPLAI of either 30 ml of normal saline (C) or 30 ml of 0.5% bupivacaine at the beginning (PE) or at the end of the surgery (PS) using a double-dummy technique. The primary outcome was the intensity of postoperative pain by visual analogue scale score (VAS) at 30 minute, 1, 2, 4, 6, 24 hours after surgery and time to the first request for analgesia. The secondary outcomes were analgesic request rate in 24 hours; duration of hospital stay and time to return to normal activity. Data were compared using analysis of variance, Kruskal-Wallis or Chi-square test.Results:For all predefined time points, VAS in group PE was significantly lower than that in groups C (P < 0.05). The time to first analgesic request was shortest in group C (238.0 ± 103.2 minutes) compared to intervention group (PE, 409.2 ± 115.5 minutes; PS, 337.5 ± 97.5 minutes;P < 0.001). Time to attain discharge criteria was not statistically different among groups.Conclusion:Pre-emptive intraperitoneal local anaesthetic instillation resulted in better postoperative pain control along with reduced incidence of shoulder pain and early resumption of normal activity in comparison to post surgery IPLAI and control.

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“…Few recent studies also not analysed the effects of improved pain relief on attaining early discharge criteria or resumption of daily routine activity. [ 8 9 10 ]…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A comparative evaluation of pre-emptive versus post-surgery intraperitoneal local anaesthetic instillation for postoperative pain relief after laparoscopic cholecystectomy: A prospective, randomised, double blind and placebo controlled study

et al. 2019

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“…Given the origin of visceral pain, one could expect that gallbladder bed infiltration with LA would provide analgesia. However, intraperitoneal administration of bupivacaine (0.5%,20 mL) was inferior to trocar site infiltration with the same amount of bupivacaine [133]. Addition of intraperitoneal instillation of lidocaine and bupivacaine to WI with 0.125% bupivacaine was not sufficient [134,135].…”

Section: Laparoscopic Cholecystectomymentioning

confidence: 99%

Updates on Wound Infiltration Use for Postoperative Pain Management: A Narrative Review

Stamenković

Bezmarević

Bojić

et al. 2021

JCM

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Local anesthetic wound infiltration (WI) provides anesthesia for minor surgical procedures and improves postoperative analgesia as part of multimodal analgesia after general or regional anesthesia. Although pre-incisional block is preferable, in practice WI is usually done at the end of surgery. WI performed as a continuous modality reduces analgesics, prolongs the duration of analgesia, and enhances the patient’s mobilization in some cases. WI benefits are documented in open abdominal surgeries (Caesarean section, colorectal surgery, abdominal hysterectomy, herniorrhaphy), laparoscopic cholecystectomy, oncological breast surgeries, laminectomy, hallux valgus surgery, and radical prostatectomy. Surgical site infiltration requires knowledge of anatomy and the pain origin for a procedure, systematic extensive infiltration of local anesthetic in various tissue planes under direct visualization before wound closure or subcutaneously along the incision. Because the incidence of local anesthetic systemic toxicity is 11% after subcutaneous WI, appropriate local anesthetic dosing is crucial. The risk of wound infection is related to the infection incidence after each particular surgery. For WI to fully meet patient and physician expectations, mastery of the technique, patient education, appropriate local anesthetic dosing and management of the surgical wound with “aseptic, non-touch” technique are needed.

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“…Port-site infiltration with local anaesthetics is another effective method of providing analgesia after laparoscopic cholecystectomy. [ 6 ] However, there is a paucity of literature comparing the efficacy of these two methods, so we planned this study.…”

Section: Introductionmentioning

confidence: 99%

Comparison of ultrasound-guided bilateral subcostal transversus abdominis plane block and port-site infiltration with bupivacaine in laparoscopic cholecystectomy

et al. 2018

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Background and Aims:Many patients experience moderate-to-severe pain after laparoscopic cholecystectomy. We aimed to compare the efficacy of ultrasound-guided bilateral subcostal transversus abdominis plane (TAP) block with port-site infiltration for post-operative analgesia after laparoscopic cholecystectomy.Methods:Patients undergoing elective laparoscopic cholecystectomy under general anaesthesia were divided into two groups of 40 each to receive ultrasound-guided bilateral subcostal TAP block (T) with 0.25% bupivacaine 20 ml each side or port-site infiltration with 0.5% bupivacaine 5 ml each at 4 ports (I) at the end of the surgery before extubation. All patients received paracetamol 1 g intravenous 8th hourly. Tramadol 1 mg/kg intravenous bolus and diclofenac 1 mg/kg intravenous infusion were used as the first- and second-line rescue analgesics when Numerical Rating Scale (NRS) ≥4, or when the patient complained of pain. NRS at 1, 2, 3, 6, 12 and 24 h after surgery, time to first analgesic request and total dose of analgesics in 24 h were recorded. Chi-square test and independent t-test were used to compare qualitative and quantitative data, respectively.Results:Time to first analgesic (mean±SD) in Group I and Group T was 292.7 ± 67.03 and 510.3 ± 154.55 min and mean tramadol required was141.8 ± 60.01 mg and 48.69 ± 36.14 mg, respectively (P = 0.001 for both). Mean NRS at 2, 3, 6, 12 and 24 h was significantly lower in Group T.Conclusion:Ultrasound-guided bilateral subcostal TAP block provides superior post-operative analgesia after laparoscopic cholecystectomy compared to port-site infiltration.

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Comparison of Intraabdominal and Trocar Site Local Anaesthetic Infiltration on Postoperative Analgesia After Laparoscopic Cholecystectomy

Cited by 18 publications

References 20 publications

A comparative evaluation of pre-emptive versus post-surgery intraperitoneal local anaesthetic instillation for postoperative pain relief after laparoscopic cholecystectomy: A prospective, randomised, double blind and placebo controlled study

A comparative evaluation of pre-emptive versus post-surgery intraperitoneal local anaesthetic instillation for postoperative pain relief after laparoscopic cholecystectomy: A prospective, randomised, double blind and placebo controlled study

Updates on Wound Infiltration Use for Postoperative Pain Management: A Narrative Review

Comparison of ultrasound-guided bilateral subcostal transversus abdominis plane block and port-site infiltration with bupivacaine in laparoscopic cholecystectomy

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