Bupivacaine Instillation into Gallbladder Bed after Laparoscopic Cholecystectomy: Does It Decrease Shoulder Pain?

Abstract

BACKGROUND: Shoulder pain is common after laparoscopic cholecystectomy (60.5%) and can delay return to normal activities. The cause is unclear but may involve referral of pain from the traumatized area. PATIENTS AND METHODS: A total of 75 patients with chronic cholecystitis who underwent laparoscopic cholecystectomy were randomized into two groups. Group I (37 patients) had 10 mL of 0.25 % bupivacaine instilled into the gallbladder bed and Calot's triangle area at the end of cholecystectomy. Group II (38 patients) served as controls and had no bupivacaine instillation. Postoperative shoulder pain was evaluated. RESULTS: Six patients in Group I developed shoulder pain (16%) compared with 23 patients in Group II (60.5%). The difference was statistically significant (P = 0.0002). CONCLUSION: The raw area of the removed organ is at least partially responsible for shoulder pain after laparoscopic cholecystectomy. Local bupivacaine is effective in reducing such pain.