Intraperitoneal Bupivacaine as Post-laparoscopic Cholecystectomy Analgesia

Abstract

Objective: To assess the efficacy of large volumes of diluted intraperitoneal bupivacaine in post-laparoscopic cholecystectomy analgesia.

Study design: A randomised controlled trial.

Place and duration of study: Department of General Surgery, Nishtar Hospital, Multan, from August 2018 to June, 2019.

Methodology: Two equal groups with 55 patients each were formed. Normal saline 500 ml in group A, and mixture of 20 ml 0.5% bupivacaine in 480 ml normal saline in group B, was used to irrigate peritoneal cavity. Final outcome of the study was the comparison of pain-free duration. Postoperatively, numerical rating scale (NRS) score at various intervals and total analgesics requirement within 24 hours after the procedure were included in the secondary outcomes. Student's t-test was applied on continuous data and Pearson's Chi-square test on nominal variables. P >0.05 was considered of no statistical significance.

Results: Both groups were comparable for age, weight, gender, duration of surgery. Postoperative analgesia duration was 0.99 ± 0.51 hours in group A and 16.53 ±2.65 hours in group-B (p<0.001). On average, 124.80 ±26.68 mg and 31.00 ±14.98 mg tramadol was given to group A and B patients, respectively (p<0.001). There was statistically significant difference in NRS score at 30 minutes, 1, 3, 6 and 12 hours postoperatively (p<0.05). NRS score at ETT extubation and at 24 hours was statistically not different (p >0.05).

Conclusion: Large volume of diluted bupivacaine when injected intraperitoneally during laparoscopic cholecystectomy provides prolonged time pain relief.