Evaluation of postoperative pain relief with intra-peritoneal bupivacaine instillation in laparoscopic cholecystectomy- a randomized control study

Abstract

Background: Laparoscopic cholecystectomy is the surgical procedure of choice for symptomatic cholelithiasis due to the improved postoperative course, but patients undergoing laparoscopic cholecystectomy during the first 24 hours postoperatively complaints of pain. This study was designed to study the efficacy of intraperitoneal bupivacaine in reducing the initial postoperative pain and also to evaluate the postoperative shoulder tip pain, nausea and vomiting.Methods: Patients undergoing laparoscopic cholecystectomy were randomized into two groups the, study group received intraperitoneal bupivacaine 100mg at the end of the procedure and the control group received intraperitoneal saline. Post operatively patients were assessed for pulse rate, blood pressure, VAS, VRS, shoulder pain and nausea and vomiting at 0, 2, 6 and 24 hours.Results: Among the 50 patients studied, our study proved that there is no statistical significant reduction in pain with intraperitoneal bupivacaine. The VAS at 0, 2, 6 and 24 hours calculated with non-significant p-value of 0.85,0.29, 0.72 and 0.64 respectively and the VRS had p-value of 0.16, 0.08, 0.59 and 0.46 respectively and the doses of rescue analgesia consumed had p value of 0 .67, 0.61 and 0.70 which were not significant statistically.Conclusions: Instillation of 100mg bupivacaine did not significantly reduce the need for tramadol compared with saline.

Comparing the effects of Bupivacaine and Ropivacaine Instillation for Postoperative Analgesia in Patients Undergoing Lumbar Spine Surgery: A Prospective Randomised Double Blind Study

“…The variation in heart rate and mean arterial pressure between the groups does not show statistically significant difference (p > 0.05). The results correlate to the study done by Agrawal S et al 15 who evaluated postoperative pain relief with intra-peritoneal bupivacaine instillation in laparoscopic cholecystectomy. The observed mean heart rate, systolic blood pressure, diastolic blood pressure between both groups was statistically not significant.…”

“…The local anaesthetic inhibits nociception by affecting nerve membrane associated proteins and by inhibiting the release and action of prostaglandins and other agents that sensitize or stimulate the nocicepters and contribute to inflammation. 15 However, absorption from dura meninge surface may also occur, which may be a further mechanism of analgesia.…”

A Randomized Controlled Trial Depicting Postoperative Pain Score Following Port-site Infiltration during Laparoscopy

“…7 A more recent study by Agrawal in 2017 also showed that there was no significant difference in postoperative pain scores between bupivacaine and control group in the immediate postoperative period following laparoscopic cholecystectomy. 8 This is in contrast to a similar study in Egypt in 2002 done by Shalan et al for laparoscopic pelvic surgery, who found that pain score and the analgesic dose required were lower in bupivacaine group. 9 Hasaniya et al in 2001 also studied the effect of preincisional bupivacaine instillation and concluded that the mean pain scores were lower as compared to controls at 4th and 24th hour postoperatively.…”

Wound Infiltration and Instillation Technique for Postoperative Analgesia Using Bupivacaine in Patients Undergoing Lumbar Spine Surgeries

“…They found no statistically significant difference in systolic and diastolic blood pressure between study groups. Similarly, Agrawal et al evaluated postoperative pain relief with intra-peritoneal bupivacaine instillation in laparoscopic cholecystectomy and observed that hemodynamic parameters were statistically not significant between the groups [ 19 ].…”