Efficacy of intraperitoneal local anaesthetic techniques during laparoscopic cholecystectomy

Abstract

Intraperitoneal techniques of LA during LC decrease postoperative pain and shorten time in theatre recovery. Injection of LA to the right hemidiaphragm is associated with lower pain scores for a longer period following LC than a previously validated wash technique.

Can Intraperitoneal Tramadol decrease Pain in Patients undergoing Laparoscopic Cholecystectomy in Postoperative Period? A Randomized Controlled Trial

“…8 The peritoneal origin of the pain suggests that analgesia delivered locally to the peritoneal cavity may be of benefit postoperatively. 9 While some studies show that intraperitoneal instillation of drugs for pain relief is more effective if used before creation of pneumoperitoneum, 10 others suggest it to be more effective at the end of the surgery. 11 So, considering these facts the present study was undertaken to evaluate analgesic effect of intraperitoneal tramadol in patients undergoing laparoscopic cholecystectomy.…”

Effectiveness of Local Anesthetics in Laparoscopic Cholecystectomy

“…1,3,4,6,8,9 Pain is multifactorial and complex, and may originate from incision, the resection, peritoneal irritants such as bile and blood, carbon dioxide insufflations, and residual gas. 1,3,4,8,10,11 Also, preventive analgesia, acting through different mechanisms, could reduce central sensitization and postoperative pain. Multimodal analgesia is thought to be more efficient.…”

Efficacy of intraperitoneal and intravenous lidocaine on pain relief after laparoscopic cholecystectomy

“…This observation supports the idea that post-LC pain, transmitted via the somatic pain fibres of the diaphragm, contributes a greater proportion of a patients' pain than that transmitted via the autonomic visceral pain fibres from the liver capsule and gallbladder peritoneum. 28 Therefore, in the current study, LA was sprayed on the upper surface of the liver, under the right subdiaphragmatic space, under the left subdiaphragmatic space and around the cholecystectomy site. Another study concluded that the peritrocal infiltration of LA and the IP instillation of LA significantly lowered the intensity of postoperative pain in a synergistic fashion.…”

“…26 Research has validated the effect of a topical wash (liver and gallbladder surface wash). 27 Additionally, Roberts et al 28 compared two different techniques for the IP delivery of local anaesthetic (LA) during LC, with a control group of patients (who were not operated on) receiving the same treatment. The authors found that subperitoneal diaphragm injections of LA decreased postoperative pain and shortened recovery room stays.…”

“…29 It should be noted that IP lidocaine administration, especially subperitoneal diaphragmatic injection, may result in complications (e.g., temporary loss of diaphragmatic function, pneumothorax or haematoma). 28 Both IV lidocaine infusion and IP lidocaine administration have been documented to be useful options for postoperative pain control after LC in several studies. 4,25,29 However, in a patient with an intra-abdominal infection (such as panperitonitis or loculated peritoneal fluid collection), IP administration involves the risk of turning a localized infection into generalized peritonitis.…”