Effect Of Bupivacaine On Postoperative Pain After Laparoscopic Cholecystectomy

Abstract

OBJECTIVE: To determine whether intraoperative local injection of 0.5% bupivacaine around port sites would decrease early postoperative pain after laparoscopic cholecystectomy, and the use of intravenous opioid analgesics postoperatively. STUDY DESIGN: Randomised controlled trial. PLACE AND DURATION OF STUDY: Department of Surgery, Khyber Teaching Hospital, Peshawar, from July 2016 to June 2017. METHODOLOGY: Patients who underwent laparoscopic cholecystectomy were divided into two groups. Group A had instillation of 20 ml of 0.5% Inj. bupivacaine at the end of procedure into port sites and group B had no bupivacaine injection at trocar sites. Both groups had postoperative intravenous ketorolac 30 mg three times daily and intravenous opioid analgesics on demand. Pain was assessed 2 hours after recovery from general anesthesia, and at 6, 12 and 24 hours through visual analog scale 0-10. RESULTS: One hundred and twenty patients completed this study with 60 patients in each group. A significant difference in mean postoperative pain scores was observed at 2 and 6 hours after surgery between the groups. Pain scores at 2 and 6 hours after surgery were 3.97 +1.327 and 3.02 ±1.08 in group A, while it was 4.65 +1.448 and 4.72 ±1.277 in group B with p-values of 0.008 and 0.005, respectively. There was no significant difference in mean postoperative pain scores at 12 and 24 hours between the groups, with pain scores of 3.72 ±0.78 and 3.75 ±0.95 (p=0.488 and 0.744, respectively). However, there was a significant difference in opioid analgesics use in first 24 hours with less analgesics use in bupivacaine injected group. CONCLUSION: Injecting 0.5% bupivacaine at trocar sites during laparoscopic cholecystectomy offers significant reduction in early postoperative pain.