Evaluation of Different Techniques for Pain Relief After Laparoscopic Cholecystectomy

Abstract

Laparoscopic cholecystectomy is the procedure of choice for treatment of gallstones. Pain after laparoscopy may be moderate or even severe in some patients and requires more than opioid treatment. Inadequately treated pain is a major cause of increased postoperative morbidity. The sympathetic stimulation resulting from pain can lead to tachycardia, arrhythmias, hypertension and increased myocardial strain and oxygen demands. Also, the pulmonary functions can be dramatically diminished by surgically induced pain which is usually secondary to reduced ability to cough to expand the lungs and clear secretions. This study was carried on sixty adult patients, ASA physical status I or II, from both sexes, scheduled for elective laparoscopic cholecystectomy. Patients were randomly allocated into four equal groups according to the technique used for postoperative pain relief. group I (control group) received 0.1 mg/kg IM morphine and 20 mg tenoxicam intravenously, group II (intraperitoneal group) received 20 mL of 0.25% bupivacaine intraperitoneally, group III (thoracic epidural group) received 8 mL 0.25% bupivacaine through a thoracic epidural catheter, and group IV (interpleural group) received 20 mL of 0.25% bupivacaine through interpleural catheter. The aim of the present study was to evaluate and to compare the efficacy of different techniques for pain relief after laparoscopic cholecystectomy, with accompanied hemodynamic changes, respiratory rate changes, and side effects.