The Effect of Preoperative versus Postoperative Intra-Incisional Bupivacaine - Lidocaine Mixture Infiltration on Early Postoperative Pain after Laparoscopic Cholecystectomy

Abstract

Objective: To compare the postoperative pain relief quality of intra-incisional local infiltration of lidocaine-bupivacaine mixture, pre-or post-laparoscopic cholecystectomy. Methods: Our prospective and randomized investigation included 110 adult patients, of both genders, middle aged, classed I-II by the American society of anesthesiologists and scheduled for elective laparoscopic cholecystectomy after written informed consent and local ethics committee approval had been obtained at Prince Ali Bin Hussein Hospital, Karak-Jordan, during the period of January 2012 to July 2013. After induction of intravenous general anesthesia, patients were divided into two groups in a random manner. Group I received local infiltration prior to incision of 15ml of bupivacaine 0.25% mixed with 5ml of lidocaine 1%, subcutaneously, 14ml in the 10mm trocar site incisions and 6ml at the 5mm trocar site. Group II received the same volume; dose and division of local anesthesia incisional injection after the trocar sites were sutured. Postoperative pain quality was evaluated during the first six postoperative hours using the visual analogue scale, and the data was analyzed for significance. Results: Mean postoperative pain score was significantly less in group II than in group I, especially at six hours where it was 3.1 and 1.1 in groups I and II, respectively (p<0.05). Postoperative morphine demand was 78.8% and 41.4% in groups I and II, respectively (p<0.05). Conclusions: Intraincisional local infiltration after incision suturing is more effective than before incisions making, in managing postoperative pain after laparoscopic cholecystectomy.

Comparison of intraincisional and intraperitoneal infiltration of local anaesthetic in laparoscopic cholecystectomy to control early postoperative pain.

“…Omar Abuelaish and colleagues from Jordan also reported similar findings. 7 However, Saurabh Agrawal 18 concluded that intraperitoneal instillation of bupivacaine does not reduce postoperative pain significantly. Marcelo S also described similar observations.…”

“…It avoids complications associated with opioids such as postoperative nausea vomiting and respiratory depression. 7 Patient has smooth recovery and early discharge from hospital. Bupivacaine is an amide local anaesthetic.…”