Evaluation of Intraperitoneal and Port Site Administration of Bupivacaine for Postoperative Analgesia Following Laparoscopic Cholecystectomy : A Randomized Controlled Study

Volume 1 - Issue 5

Shilpashri A M¹*, Rashmi C2 and Priya R³

Received:July 07, 2019;   Published:July 12, 2019

DOI: 10.32474/GJAPM.2018.01.000124

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Abstract

Background:Laparoscopic cholecystectomy has become the procedure of choice for gall bladder removal. Post-operative pain management involves the use of opioids, non-steroidal anti-inflammatory drugs [NSAIDs], paracetamol and local anesthetics. Opioids may delay recovery and discharge from the hospital. NSAIDS cause gastric irritation in addition to impairing platelet and renal function. Instilling local anesthetic intra-peritoneally and through port sites is a non- invasive method to provide excellent analgesia in the immediate postoperative period. Bupivacaine is a long acting local anesthetic devoid of any serious side effects when given as local infiltration. Objective: To evaluate the effectiveness of bupivacaine in reducing postoperative pain after laparoscopic cholecystectomy when given intra-peritoneally and through port site infiltration. Materials and methods: 100 patients who underwent laparoscopic cholecystectomy were divided into 2 equal groups. In Group B 50 patients received 20ml of 0.25% bupivacaine given intraperitoneally and another 10ml of same for port site infiltration. In Group A 50 patients received 0.9% Normal saline 20ml and 10ml respectively at the same sites. Postoperative pain need for rescue analgesics, vital parameters and adverse effects were monitored in the post- operative period. Results: Both the study groups were similar in terms of age structure and majority were female gender. Postoperative pain was significantly reduced in the bupivacaine group. Most of patients who received normal saline needed rescue analgesia immediately in the postoperative period compared to very few patients in group B. There were statistically significant changes in the postoperative vital signs in both the study groups. Conclusion: Intraperitoneal and periportal infiltration of 0.25% bupivacaine is a simple, cost effective and minimally invasive method that provides early analgesia after laparoscopic cholecystectomy with no adverse effects and may become routine practice reducing the analgesic consumption in the immediate postoperative period.

Keywords: Ropivacaine; Bupivacaine; Laparoscopic cholecystectomy; Intraperitoneal

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