Intraperitoneal Bupivacaine in Laparoscopic Cholecystectomy, Efficacy and Feasibility

Abstract

L aparoscopic Cholecystectomy among the most frequently performed elective daycare surgeries. After laparoscopic cholecystectomy shoulder and abdominal pain causes considerable distress. To determine the efficacy of intraperitoneal bupivacaine instillation on management of early postoperative pain in patient undergoing laparoscopic cholecystectomy This is a prospective randomized study with sample size of 50 patients underwent elective laparoscopic cholecystectomy. We recruited patients from surgery department at Agouza Hospital. We randomly assigned patients to undergo laparoscopic cholecystectomy with bupivacaine and 25 ml of physiological saline (0.9% normal saline) on liver bed or without bupivacaine. Patients were subjected to detailed history taking and clinical examination. Our primary outcomes were visual analog scale (VAS) and verbal rating scale (VRS) at 2, 12 and 24hr postoperative. Our secondary outcomes include length of hospital and intensive care unit stay, need of additional analgesic and the incidence of nausea and vomiting Fifty patients finally met our inclusion criteria. In bupivacaine group, mean age was 35 (± 6.6), 64% were females and 36% were males. While in non-bupivacaine group mean age was 37.6 (± 6.6), 68% were females and 32% were males with no statistically significant difference between both groups; age (P value=0.22) and age (P value=0.77). In bupivacaine group there was significant pain reduction compared to non-bupivacaine group in terms of VAS at 2 h (p value=0.04), 12 h (p value=0.02), 24 h (, p value=0.01) and VRS at 2 h (p value<0.01), 12 h (p value<0.01), 24 h (p value<0.01). Hospital stay was lower hospital stay in bupivacaine group 0.94 (± 0.16) than non-bupivacaine group 1.21 (± 0.41) (p value<0.01). Need for additional analgesia was lower in bupivacaine group (P value <0.01). There was no significant difference between both groups regarding surgery duration (p =0.57), incidence of nausea (P value= 0.09) and vomiting (P value= 0.31).