A Randomized Placebo Controlled Trial to Assess Post Operative Analgesia After Intraperitoneal Instillation of 0.5% Bupivacaine in Laparoscopic Cholecystectomy

Abstract

Background and objectives ABSTRACT Although laparoscopic cholecystectomy is characterized by reduced postoperative pain, many patients still complain of moderate abdominal and shoulder pain during the first 48 hours. The objective of this study was to compare effect of intraperitoneal instillation of 0.5% bupivacaine versus saline for post-operative analgesia in laparoscopic cholecystectomy. Methodology 36 adult patients admitted to department of surgery posted for elective laparoscopic cholecystectomy in KLES Dr. Prabhakar Kore Hospital & MRC, Belgaum between age group 18 to 60 years of ASA-1 and ASA-2. 36 patients undergoing elective laparoscopic cholecystectomy were prospectively randomized into 2 groups. Group ( A ) – Study group: Patients received 20 ml 0.5% bupivacaine intraperitoneally at gall bladder bed and under right and left hemidiaphragm at the end of surgery through laproscope port in trendelenburg position. Group ( B ) - Placebo group: Patients received 20 ml normal saline intraperitoneally at the same location. The evaluation of postoperative pain was done at fixed time interval according VAS. Analgesic requirements were analyzed. Shoulder tip pain was also assessed. Results Mean pain scores upto 12 hours after surgery were lower in group ( A ) compared to group ( B ) . This difference was statistically significant ( p<0.05) . The incidence of shoulder tip pain was not significant. However, pain scores after IV 12 hours did not differ significantly between the two groups. The mean total NSAID’s usage in group( A ) was lower as compared to group ( B ) and was found to be statistically significant ( p<0.001 ) . Conclusion To conclude, bupivacaine is effective in preventing pain over the first 12h after laparoscopic cholecystectomy when intraperitoneally instilled at the end of surgery and also reduces the analgesic requirement.