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. 2021 Dec 27;11(6):e114623.
doi: 10.5812/aapm.114623. eCollection 2021 Dec.

Comparison of Intraperitoneal Bupivacaine and Intravenous Ketorolac for Postoperative Pain Management Following Laparoscopic Cholecystectomy

AmirAhmad Arabzadeh  1 , Mirsalim Seyedsadeghi  1 , Nahideh Sadeghi  1 , Kazem Nejati  2 , Ali Mohammadian Erdi  3
Affiliations

Comparison of Intraperitoneal Bupivacaine and Intravenous Ketorolac for Postoperative Pain Management Following Laparoscopic Cholecystectomy

AmirAhmad Arabzadeh et al. Anesth Pain Med. .

Abstract

Background: Postoperative pain following laparoscopic cholecystectomy (LC) arises from incision sites and residual intraperitoneal CO2 gas. Opioids as a class of pain-relieving drugs are broadly used to control pain after LC; however, these drugs can cause various side effects.

Objectives: The purpose of this study was to compare the efficacy of intraperitoneal injection of bupivacaine with that of intravenous ketorolac in managing postoperative pain in patients who had undergone LC.

Methods: This randomized, double-blind clinical trial was carried out on patients who had undergone LC. Ninety patients who had undergone elective LC were randomly divided into 3 groups (n = 30 for each group). Group A received 40 mL of 0.25% bupivacaine solution intraperitoneally at the end of the operation; group B received 30 mg of ketorolac intravenously 30 minutes before surgery and every 8 hours after surgery, and patients in group C received normal saline intraperitoneally and intravenous injection. The patients were postoperatively assessed for Visual Analog Scale (VAS) scores, postoperative opioid consumption, shoulder pain, side effects (sedation, nausea, and vomiting), and satisfaction. The data were analyzed using SPSS. P values < 0.05 were considered significant.

Results: The intraperitoneal injection of bupivacaine and intravenous injection of ketorolac were significantly effective in reducing postoperative abdominal pain, shoulder pain, and incidence of nausea and vomiting compared to the placebo group (P < 0.001). Although intraperitoneal bupivacaine and intravenous ketorolac had no significant difference in pain relief compared with each other, patients in both bupivacaine and ketorolac groups were significantly more satisfied with their analgesia compared to the control group (P < 0.001).

Conclusions: Intraperitoneal injection of bupivacaine and intravenous injection of ketorolac both are safe and effective methods to control pain, nausea, and vomiting after LC.

Keywords: Bupivacaine; Intraperitoneal Injection; Ketorolac; Laparoscopic Cholecystectomy; Postoperative Pain.

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Conflict of interest statement

Conflict of Interests: The authors have declared no conflict of interest.

Figures

Figure 1.
Figure 1.. Flowchart of the study
Figure 2.
Figure 2.. Comparison of the pain scores (Visual Analog Scale) in the experimental groups at postoperative times. Values are represented as mean ± SD. Differences between the results of the placebo group and other groups (*** P < 0.001; n = 30 for each group).
Figure 3.
Figure 3.. Percentage of the nausea incidence in the experimental groups 24 hours after surgery (n = 30 for each group).
Figure 4.
Figure 4.. Comparison of the shoulder pain in the experimental groups at postoperative times. Values are represented as mean ± SD. Differences between the results of the placebo group and other groups (*** P < 0.001; n = 30 for each group).
Figure 5.
Figure 5.. Comparison of the postoperative analgesic consumption in the experimental groups at postoperative times. Values are represented as the number of frequency. Differences between the results of the placebo group and other groups (*** P < 0.001; n = 30 for each group).
Figure 6.
Figure 6.. Patients’ satisfaction with analgesia in the studied groups. Values are represented as mean ± SD (n = 30 for each group).
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