Comparison of postoperative pain in laparoscopic cholecystectomy with and without instillation of bupivacaine in the gall bladder bed

Abstract

Laparoscopic surgery is a modern surgical technique in which operations in
the abdomen is performed through small incisions. Cholecystectomy is the surgical
removal of the gallbladder. Laparoscopic cholecystectomy is the most common
laparoscopic procedure performed. The most common problem after laparoscopic
cholecystectomy is the postoperative pain. One of the good procedures is to instil a local
anaesthetic agent at the area from where gall bladder is removed. Inj. Bupivacaine 0.5 % is a
long-acting local anaesthetic. It is effective in reducing postoperative pain after
Laparoscopic Cholecystectomy.
OBJECTIVE: To compare the mean postoperative pain in laparoscopic cholecystectomy
with and without instillation of 0.5% bupivacaine in the gall bladder bed.
OUTCOME MEASURE: The outcome was measured as pain post operatively at 0, 2, 4
and 6 hours by VAS. And the number of hours after which patients requested for analgesia.
MATERIALAND METHODS:
SETTING: Department of surgery, Benazir Bhutto Hospital Rawalpindi.
DURATION: 6 months
STUDYDESIGN: Randomized Controlled Trail.
METHODS: 120 patients undergoing Laparoscopic Cholecystectomy were included
in study. Patients were divided into two groups A& B. Group A(Experimental group)
was given 10 ml 0.5% bupivacaine at gall bladder bed and under right hemidiaphragm at the
end of surgery through laproscope port and Group B (Control group) was given 10 ml
normal saline intraperitoneally at the same location. Patients were included through non
probability sampling technique.
RESULTS: 100 patients (83.3%) were female, and 20 patients (16.7%) were male. The
demographic data including age, gender, and the average duration of surgery was not
significantly different (p>0.05) in Bupivacaine and Saline group. A significant difference
was observed between the pain scores of Bupivacaine and Saline groups after 0 hours, 2
hours and 4 hours of surgery (p<0.05). However no significant difference was observed
between two groups after 6 hours of surgery (p>0.05). There was also a significant
difference in the number of hours after which patients requested for analgesia (p<0.05). The
patients of Bupivacaine group requested late for analgesia as compared to the patients of
Saline group.
CONCLUSION: Intraperitoneal instillation of Bupivacaine results in good pain relief after
laparoscopic cholecystectomy.