Port Site and Intraperitoneal Infiltration of Local Anesthetics in Reduction of Postoperative Pain after Laparoscopic Cholecystectomy

Abstract

Laparoscopic cholecystectomy is now the gold standard technique for the treatment of gallstones disease. Although pain after laparoscopic cholecystectomy is less intense than after open cholecystectomy, some patients still experience considerable discomfort during the first 24 to 72 postoperative hours. The aim of this study is to evaluate the effect of intraperitoneal and port site instillation of local anaesthetics on pain relief in early postoperative period following laparoscopic cholecystectomy. Fifty patients undergoing elective laparoscopic cholecystectomy were consecutively included in this study and sample was divided into two groups. Following removal of gallbladder, Group A received 20 ml of 0.25% bupivacaine instilled in the right sub diaphragmatic space and 20 ml of 0.25% bupivacaine in divided doses at the trocar sites. The evaluation of postoperative pain was done at fixed time interval according to the numerical verbal scale and the dosage of narcotic analgesics consumed was also recorded. Mean pain scores at 6 hours and at 12 hours after surgery were 6.02 and 4.72 respectively, in the bupivacaine group compared with 8.44 and 6.08 respectively in the control group (p= <0.001 and <0.001). However, pain scores at 24 hours and 48 hours postoperatively and incidence of shoulder tip pain did not differ significantly between the two groups. The mean total narcotic analgesics used in study group was 1.91 as compared to 2.50 in the control group respectively and was found to be statistically significant (p= <0.001). Infiltration of bupivacaine in to port site and intraperitoneal space is simple, inexpensive and effective technique to minimize early postoperative pain and can be practiced for elective laparoscopic cholecystectomy. DOI: 10.3329/medtoday.v22i1.5601 Medicine Today Vol.22(1) 2010. 24-28

Comparative evaluation of subcutaneous infiltration (port site) vs intraperitoneal infiltration of bupivacaine on post laparoscopic cholecystectomy pain

“…21 Alam et al who studied on port site and intraperitoneal infiltration of local anaesthetics in reduction of postoperative pain after laparoscopic cholecystectomy, showed port site, intraperitoneal infiltration of local anaesthetics for postoperative pain relief is, in this context, an effective alternative method for early pain control and minimize the need of analgesics. 22 Rt Shoulder-tip pain, which was slight during the first postoperative hours, tended to become predominant after 24 hr, while parietal pain and visceral pain rapidly decreased. Subdiaphragmatic administration of 80ml bupivacaine 0.125% plus epinephrine l/200,000 had no significant effect on total pain, parietal pain, visceral pain, or shoulder-tip pain as compared with saline.…”

Shoulder Tip Pain Following Laparoscopic Cholecystectomy—a Randomized Control Study to Determine the Cause

“…Shoulder pain mostly becomes apparent on the day after surgery when the visceral pain component has decreased. There are also great individual differences in pain perception after abdominal surgery [7].…”

“…A number of clinical trials have shown variable analgesic effects with a variety of methods including periportal infiltration of local anesthetics, intraperitoneal spraying above the gallbladder, and instillation into the subdiaphragmatic and subhepatic space covering the area of the hepatoduodenal ligament [7]. Bupivacaine administered in the subdiaphragmatic area is presumed to block noniceptive input generated from the inflamed diaphragmatic peritoneum [9].…”

Control Del Dolor en La Colecistectomía Laparoscópica Mediante La Aplicación De Bupivacaína en El Lecho De La Vesícula. Hospital Eugenio Espejo-Quito, 2012.

“…Así mismo un metaanálisis [20] donde fue válido la aplicación intraperitoneal de anestésico local. Dos en un estudio prospectivo, aleatorio doble ciego se encuentra efectividad en el uso de la bupivacaína para el control del dolor [21] estudian la bupivacaína empapada en una lámina de celulosa además de la infiltración en las incisiones de los trocares donde el resultado es la disminución del dolor postoperatorio [22] encuentran diferencia estadística en…”