Pain relief from combined wound and intraperitoneal local anesthesia for patients who undergo laparoscopic cholecystectomy

Abstract

Background: Laparoscopic cholecystectomy (LC) has become the treatment of choice for gallbladder lesions, but it is not a pain-free procedure. This study explored the pain relief provided by combined wound and intraperitoneal local anesthetic use for patients who are undergoing LC.

Methods: Two-hundred and twenty consecutive patients undergoing LC were categorized into 1 of the following 4 groups: local wound anesthetic after LC either with an intraperitoneal local anesthetic (W + P) (group 1) or without an intraperitoneal local anesthetic (W + NP) (group 2), or no local wound anesthetic after LC either with intraperitoneal local anesthetic (NW + P) (group 3) or without an intraperitoneal local anesthetic (NW + NP) (group 4). A visual analog scale (VAS) was used to assess postoperative pain. The amount of analgesic used and the duration of hospital stay were also recorded.

Results: The VAS was significantly lower immediately after LC for the W + P group than for the NW + NP group (5 vs. 6; p = 0.012). Patients in the W + P group received a lower total amount of meperidine during their hospital stay. They also had the shortest hospital stay after LC, compared to the patients in the other groups.

Conclusion: Combined wound and intraperitoneal local anesthetic use after LC significantly decreased the immediate postoperative pain and may explain the reduced use of meperidine and earlier discharge of patients so treated.

Figure 1

Algorithm of the group allocation for 220 patients undergoing laparoscopic cholecystectomy. LC = laparoscopic cholecystectomy; NW + NP = no wound anesthetic and no intraperitoneal anesthetic use; NW + P = no wound anesthetic but intraperitoneal anesthetic use; W + NP = wound anesthetic but no anesthetic use; W + P = wound anesthetic and intraperitoneal anesthetic use.

Figure 2

The duration of the hospital stay of the 4 groups of patients [i.e., patients who received a local anesthetic at the end of laparoscopic cholecystectomy either with an intraperitoneal local anesthetic (W + P group; n = 55) or without an intraperitoneal local anesthetic (W + NP group; n = 55), and patients who received no local wound anesthetic at the end of LC either with an intraperitoneal local anesthetic (NW + P group; n = 55) or without an intraperitoneal local anesthetic (NW + NP group; n = 55)]. *p < 0.05. The W + P patients had significantly shorter hospital stays than the NW + NP patients. All data are presented as the mean with 95% confidence interval standard deviations. NW + NP = no wound anesthetic and no intraperitoneal anesthetic use; NW + P = no wound anesthetic but intraperitoneal anesthetic use; W + NP = wound anesthetic but no anesthetic use; W + P = wound anesthetic and intraperitoneal anesthetic use.