Port Site and Intraperitoneal Infiltration of Local Anesthetics in Reduction of Postoperative Pain after Laparoscopic Cholecystectomy (original) (raw)
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Introduction: Intraperitoneal administration of local anesthetic in combination with an opioid, for the relief of postoperative pain, has already been reported after laparoscopic cholecystectomy. This study aimed to assess the analgesic effect of the intraperitoneal administration of bupivacaine and morphine, in patients undergoing laparoscopic cholecystectomy. Methods: 90 patients (30 patients in each group) were included in a double blind, randomized manner. At the end of laparoscopic cholecystectomy, the patients were intraperitoneally treated with 30 ml of: physiological saline (Group 1) or 0.25% bupivacaine (Group 2) or 0.25% bupivacaine + 2 mg morphine (Group 3). Patient's postoperative pain was evaluated using a visual analogue scale and a verbal rating score. The postoperative analgesic requirement was assessed by the total dose of Ketorolak, administered by intravenous or intramuscular route. Pain, vital signs, supplemental analgesics consumption and side effects were recorded for all patients for 12h. Results: There were no difference between the three groups, regarding pain scores (et rest and coughing) during the study, except in the fi rst 6 h, when scores were lower for patients receiving intraperitoneal bipuvacaine + morphine (p<0.05). Conclusions: In the patients undergoing laparoscopic cholecystectomy, the intraperitoneal administration of bupivacaine + morphine, reduced the analgesic requirements during the fi rst 6 postoperative hours compared with the control groups. The combination of intraperitoneal bupivacaine 0.25% and morphine was more effective for treatment of pain after laparoscopic cholecystectomy.
2020
Aim: Effective postoperative pain control is an essential component for care of surgical patients. Inadequate pain control may result in increased morbidity or mortality. Analgesic effects of periportal infiltration of local anesthetics, infiltration of periportal parietal peritoneum, intraperitoneal spraying at subdiaphragmatic space and subhepatic space covering the area of hepatoduodenal ligament have been reported. The present controlled study aimed at assessing the effect of port site injection and intraperitoneal instillation of bupivacaine in reduction of post-operative pain after laparoscopic cholecystectomy. Methods: The present study was conducted among a group of 180 patients diagnosed to have symptomatic cholelithiasis and who underwent elective laparoscopic cholecystectomy under general anesthesia. In group 1, pre-incisional local infiltration of 20ml 0.5% bupivacaine at the port sites; and in group 2, local infiltration of 20ml 0.5% bupivacaine at the port sites with i...
Background: Effective control of postoperative pain reduces the postsurgical discomfort and facilitates early ambulation. We evaluated the efficacy of trocar sites and intra peritoneal administration of bupivacaine in reducing the postoperative pain and analgesic requirement. Materials and methods: Sixty adult ASA physical status Ι to ΙΙΙ patients undergoing laparoscopic cholecystectomy were randomly assigned to receive either, 30 ml of 0.25% bupivacaine at gall bladder bed plus 20 ml of 0.25 % bupivacaine at trocar sites (Group B) or an equal volume of normal saline (Group S). Postoperative pain was assessed using 10 point Visual analogue scale every four hours for 12 hours. The total analgesic consumption in 12 hours was also assessed. Results: The mean pain total pain score were significantly less (< 0.0001 ) in Group B (2.03±0.9289) when compared to Group S (4.266±0.4767). Total tramadol consumption decreased by 56% in Group B (113.33 ± 34.57mg) compared to Group S (256.66 ± 50.4 mg).The variation was statistically significant(p < 0.0001). Total consumption of diclofenac was significantly (p < 0.0001) less in Group B than Group S (7.5±22.884 Vs 55±33.733mg). Conclusion: Local anaesthetic administration is an effective component of multimodal analgesia for reducing postoperative pain and opioid requirement after laparoscopic cholecystectomy
Background: Pain in cases of laparoscopy is a distressing side effect mainly in initial post-operative period. This randomized control study is done to evaluate the local effect of Bupivacaine instillation intraperitoneally and at port site. Subjects and Methods: Our study is a randomized controlled study of 90 cases of symptomatic cholelithiasis admitted and operated upon during the period of 24 months in the department of general surgery of our institute. The patients were randomly divided into 3 groups, Group A received intraperitoneal instillation of 20 ml of 0.5% Bupivacaine on gall bladder fossa and subdiaphragmatic region. Group B received 10 ml of 0.5%. bupivacaine on gall bladder fossa subdiaphragmatic and 10ml at the port site. Group C was the Control group who has not received any local analgesia. Postoperative pain and shoulder tip pain were then compared using Visual Analogue Scale (VAS) and Verbal Rating Scale (VRS). Results : At 2 and 4 hours pain score significantly more in Group C compared to Group B and A. After 8 hours there was no difference in pain score in all 3 groups. Time to receive first analgesia is significantly longer in group B compared to other groups. No difference in the shoulder pain in any of the groups. Conclusion: The instillation of Bupivacaine at the port site and intra-peritoneally (at the gallbladder fossa and sub-diaphragmatically), significantly decreases the pain in initial post-operative period in laparoscopic cholecystectomy.
2019
Introduction: Laparoscopic cholecystectomy is now the gold standard for treatment of symptomatic gallstones. After this surgery patients suffer visceral and shoulder pain secondary to peritoneal insufflation. Use of intraperitoneal and port site instillation of local anesthetics has been used to reduce postoperative pain and decreases the need for intravenous opioids. Studies regarding comparison of intraperitoneal use of ropivacaine and bupivacaine to reduce postoperative pain are few. This study compared the efficacy of ropivacaine and bupivacaine in reducing postoperative pain after laparoscopic cholecystectomy. Methodology: After ethical committee’s clearance and informed consent 100 patients with symptomatic cholelithiasis, aged 20-70 years, of either gender, ASA status I to III and within ± 20% of ideal body weight, scheduled for laparoscopic cholecystectomy were included. . Patients were randomized into two groups with 50 patients in each group. Group-B: Patients received 0.5...
2020
Laparoscopic cholecystectomy is a well-established procedure for gallbladder disease. The morbidity associated with conventional cholecystectomy has reduced significantly with laparoscopic cholecystectomy. In the era of laparoscopic cholecystectomy, early discharge and return to routine activity have become feasible owing to minimal invasion. The post-operative compliance from the patient and the satisfaction level has significantly improved with this technique. The management of pain in the postoperative period is crucial in aiding the recovery of the patient. The pain in laparoscopic cholecystectomy is mainly parietal somatic pain which tends to conceal the deep visceral pain experienced by the patient. Pain is associated with multiple factors in laparoscopic cholecystectomy: somatic, visceral, and phrenic nerve irritation.
International Journal of Current Research and Review
The complex humoral and neuronal response that occurs with surgery requires a balanced approach for perioperative pain management with minimal side effects from anaesthetic and analgesic drugs. 3 The growing evidence suggests that treatment of postoperative pain should be preemptive, multimodal and opioid-sparing to accelerate recovery and avoid potential side effects. Intraperitoneal instillation of the local anaesthetic agent into gall bladder bed has been proved to be an effective method of postoperative analgesia in laparoscopic .
INTRAPERITONEAL BUPIVACAINE FOR POSTOPERATIVE PAIN RELIEF AFTER LAPAROSCOPIC CHOLECYSTECTOMY
Pain is defined as “an un-pleasant sensory and emotional experience associated with actual or potential tissue damage”.Laparoscopic cholecystectomy is now an established form of treatment for patients with symptomatic gallstones. Recent studies have shown that patients may experience considerable pain after laparoscopic cholecystectomy. The various methods used with variable success are NSAID’S, infiltration of wound with local anesthetics and intermittent intramuscular narcotics. In Laproscopic Cholecystectomy after removal of gall bladder from the abdominal cavity using an endobag the position of the patient was made supine and 0.25% of 10 ml bupivacaine was instilled in the gall bladder fossa under direct laparoscopic control in Group A patients while Group B patients did not receive any such solution.Group A showed less intensity of pain with time duration as compared to Group B. A descriptive analysis of the VAS pain scores was in table 1. Statistically significant stepwise decrease in pain score at 4 hrs, 8 hrs, 12 hrs and 24 hrs were found in Group A and B. Intraperitoneal bupivacaine for laparoscopic cholecystectomy in a dose of 10 ml of 0.25% rather than using a higher dose reduces pain in the initial postoperative period and also in first 24 hrs, it is easy to administer with no adverse effects and may become a routine practice for this procedure.
Background: To determine the effect of local anesthetic intraperitonel instillation on post-op pain relief after laparoscopic cholecystectomy. Methods: In this randomized controlled trial 64 patients, diagnosed as having gallstones , were divided into 2 groups for laparoscopic cholecystectomy. In Group A Intraperitoneal irrigation of the diaphragmatic surface and gallbladder fossa was done with 0.5% bupivacaine, while in Group B no drug was used intraperitoneally. Results: Out of 32 patients enrolled as bupivacaine group, 27 were female and 5 were male patients with average age of 46.12 years, whereas in control group, there were 28 female and 04 male patients in a total of 32 patients, and the avrage age was 45.36 years. Mean VAS scores in bupivacaine group at 8, 16 and 24 hrs were 3.875, 2.5625 and 0.75 respectively, while they were 6.50, 3.25 and 0.875 in controls at 8, 16 and 24hrs respectively. VAS scores tended to be higher in females. Need for post-op analgesia in 1st 8hrs & 1 st 16hrs was more in the controls(87.50% & 56.25% respectively). The need for post-op analgesia at 24hrs after surgery was almost equal in both groups. Post-op pain relief in 1st 8hrs was better in the bupivacaine group i.e. 31.25% vs. 12.5%. Conclusion: The early post-op VAS scores and pain intensity after 8hrs & 16hrs is decreased with the use of intra-peritoneal instillation of injection Bupivacaine, but in long term it offers no added benefit to the post-operative pain relief and does not decrease the need for analgesia post-operatively.
2015
Purpose: Pain after laparoscopic cholecystectomy is less intense than after open cholecystectomy, some patients still experience considerable discomfort especially with coughing, respiratory movements and mobilization during initial few hours after surgery or during night after surgery. Material and Methods: Study included 200 patients who underwent laparoscopic cholecystectomy. They were divided into two groups of 100 patients each. One group (experimental) received bupivacaine and other group (Control) received 30 ml of normal saline after completion pf laparoscopic cholecystectomy. Results: Mean time of requirement of rescue analgesia in experimental group was 8.5 hours, whereas mean time of requirement of rescue analgesia in controls was 7.29 hrs. Total consumption of diclofenac in cases was 95mg whereas in controls it was 108.75mg (p=0.246), while as total consumption of tramadol in cases was 50 mg, whereas in controls it was 130mg (p<0.05). Postoperative abdominal pain as w...