The effect of incisional infiltration of bupivacaine hydrochloride upon pulmonary functions, atelectasis and narcotic need following elective cholecystectomy

Abstract

Forty randomly selected patients admitted for elective cholecystectomy were entered into the study after they have given informed consent. Arterial blood gas analysis, FVC and FEV1 were measured preoperatively and on the second postoperative day. Preoperatively and on the third postoperative day, roentgenograms of the chest were obtained. The frequency of administration of narcotics was recorded through day 3. The double-blind method selected 17 patients for infiltration of 50 milliliters of 0.25 per cent bupivacaine hydrochloride into the wound and 23 patients for infiltration of 50 milliliters of normal saline solution at the time of closure of the incision. In the saline solution group, postoperative FVC and FEV1 values were only 50 per cent of the preoperative levels (p less than 0.005), while in the bupivacaine hydrochloride group, the FEV1 value was 72 per cent of the preoperative values (p less than 0.05) and the FVC, 78 per cent (p less than 0.05). Roentgenographic evidence of atelectasis occurred postoperatively in four patients of the saline solution group and in only nine patients of the bupivacaine hydrochloride group (p less than 0.001). The saline solution group required 10.8 doses of narcotic through day 3 in contrast with 6.5 doses for the bupivacaine hydrochloride group (p less than 0.05). The hospital stay was 6.6 days for those in the saline solution group and 5.9 days for those in the bupivacaine hydrochloride group (p value, not significant). No complications occurred. Intraoperative infiltration of bupivacaine hydrochloride into the wound improves pulmonary function, reduces the incidence of atelectases and lessens the use of narcotics following cholecystectomy.