Pain Intensity after Laparoscopic Cholecystectomy with Intraperitoneal Irrigation as Well As Periportal Infiltration of Bupivacaine Versus Without Bupivacaine

Abstract

Objective: To compare the effectiveness of bupivacaine as intraperitoneal irrigation and local infiltration at port sites in terms of postoperative pain reduction to a control group that did not receive any bupivacaine injection.

Methodology: This study was carried out in the general surgery department of Liaquat University Hospital Hyderabad/Jamshoro from 2018 to 2019. Patients of uncomplicated gallstone disease, aged more than 12 years old admitted through the outpatient department, as well as from casualty department, undergoing laparoscopic cholecystectomies were included. Patients were randomly divided into two groups. At the end of surgery, the study group received bupivacaine as intraperitoneal irrigation and local infiltration bupivacaine in the port sites while the control group didn’t receive bupivacaine, admitted in the department of surgery, who came for uncomplicated gallstone disease as assessed preoperatively. Patients were assessed for postoperative pain up to 48 hours after surgery and pain was evaluated by visual analogue scale.  All the information was collected via study proforma. SPSS version 26 was used for the data analysis.

Results: There was no difference between the two groups preoperatively in terms of demographic and laboratory data. The two groups were observed with similar operation time, blood loss without any postoperative mortality. The pain intensity, as rated by visual analog rating scales, was significantly less in the group receiving bupivacaine than in the control group.  It was observed that there were significantly lower pain scores in the patients undergoing LC with local anesthesia, at different time interval as compared to the control patients (p<0.01). Regarding analgesia, the number of analgesia needed, were lower in patients undergoing LC with local anesthesia infiltration and irrigation than control group (p<0.010). The test group patients had a shorter hospital stay than controls.

Conclusion: It was concluded that irrigation of bupivacaine in peritoneal cavity and infiltration around the ports in LC patients significantly reduces the severity of postoperative pain and the analgesic requirement as compared to the control LC patient whom not received infiltration and irrigation with bupivacaine.