Intraperitoneal normal saline and bupivacaine infusion for reduction of postoperative pain after laparoscopic cholecystectomy (original) (raw)
Related papers
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...
Aim: To determine the pain relieving effect of 1litre intraperitoneal normal sline among patients undergoing laparoscopic cholecystectomy. Study design: It is a prospective randomized double blind study performed in surgical unit II of SIMS from March 2012 to Dec 2012. The 70 (48 female and 22male) patients included in the study who underwent Laparoscopic cholecystectomy were randomly divided into two groups (35 patients in control Group A; given local analgesia with Bupivacain only. 35 patients in group B Experimental Group B; given local analgesia with Bupivacain plus infiltration of 1litre normal saline intraperitoneally). Postoperatively patients of each group were evaluated for pain relief according to VAS. Results: In 24 female patients belonging to control group A (who were given local analgesia at port site with Bupivacain only) the average pain score was 7-8 whereas in 11 male of same group A, the average pain score was 6-7, whereas In 24 females patients belonging to exper...
Intraperitoneal Normal Saline Infusion for Postoperative Pain after Laparoscopic Cholecystectomy
World Journal of Surgery, 1998
After laparoscopic surgery carbon dioxide remains within the peritoneal cavity for a few days, commonly causing pain. This prospective randomized study was performed to determine the efficacy of intraperitoneal infusion of normal saline on postoperative pain after laparoscopic cholecystectomy. Altogether 300 patients were randomly assigned to one of five groups of 60 patients each. Group A: control group, no peritoneal infusion, no subhepatic drain. Group B: no peritoneal infusion but a subhepatic closed drain was left for 24 hours. Group C: normal saline 25 to 30 ml/kg body weight at a temperature of 37°C was infused under the right hemidiaphragm and left in the peritoneal cavity. Group D: normal saline in a room temperature was infused under the right hemidiaphragm and suctioned after the pneumoperitoneum was deflated. Group E: normal saline was infused and suctioned as in group D, but a subhepatic closed drain was left for 24 hours. Postoperatively, analgesic medication usage, nausea, vomiting, and pain scores were determined at 2, 6, 12, 24, 48, and 72 hours (during hospitalization and at home). Postoperative pain was reduced significantly (p < 0.001) in the patients of groups C, D, and E versus controls, whereas no difference was observed between groups A and B. Among groups C, D, and E, group E (p < 0.01) had the best results followed by group D and then group C. Intraperitoneal normal saline offered a detectable benefit to patients undergoing laparoscopic cholecystectomy. The beneficial effect was better when the fluid was suctioned after deflation of the pneumoperitoneum and even better when a subhepatic closed drain continued fluid suction during the first postoperative hours.
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...
Effect of intraperitoneal bupivacaine on pain after laparoscopic cholecystectomy
Acta Anaesthesiologica Scandinavica, 1995
The effect of intraperitoneal bupivacaine on postoperative pain was studied in 60 ASA 1–2 patients undergoing elective laparoscopic cholecystectomy. The patients were randomly selected (20 patients in each group) to receive in double-blind fashion 100 ml of either plain 0.15% bupivacaine {150 mg · 100 ml-1) or the same solution with adrenaline (1.5 μg ml-l), or the same volume of saline into the right subdiaphragmatic space at the end of surgery. The patients were kept in the Trendelenburg's position for 20 min after the instillation. Venous blood samples for the determination of bupivacaine plasma concentrations were drawn up to 180 min. Plasma bupivacaine concentrations peaked at 30 min (highest individual value 2.6 μg ml-1) after instillation. Bupivacaine concentrations were significantly lower in the bupivacaine-adrenaline group. During the follow-up no difference between the groups occurred as to the time to first demand of analgesia, severity of postoperative pain, amount of consumed analgesics during 7 days, and length of hospitalization. In all groups, 30–45% of the patients complained of right shoulder pain. After the first 24 hours, pain at rest and during moving was reported as mild and was managed with oral ketoprofen.It is concluded that postsurgical intraperitoneal instillation of 150 mg bupivacaine in 100 ml of saline had no effect on pain after laparoscopic cholecystectomy.
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.
International Journal of Anesthesiology & Pain Medicine, 2018
Background: Surgical and laparoscopic techniques are two different methods for the removal of gall bladder. Today, laparoscopic cholecystectomy is a preferred method for short-term hospitalization and early return to function related to minimal invasive surgical technique. However, patients still complain of significant postoperative pain, secondary inflammation of the diaphragm and the nociceptive genus of the annoying membrane's peritoneum. Multimodal analgesia is necessary for managing pain after laparoscopic cholecystectomy. Magnesium sulfate is a new emerging medication for the management of acute pain. There are no previous reports to compare the analgesic effect of intraperitoneal instillation of bupivacaine plus morphine hydrochloride and bupivacaine plus magnesium sulfate for postoperative pain after laparoscopic cholecystectomy. Aim: The purpose of this study is to compare the analgesic effect of intraperitoneal instillation of bupivacaine plus morphine hydrochloride versus bupivacaine plus magnesium sulfate in patients undergoing laparoscopic cholecystectomy under general anesthesia for better pain relief and less opioid consumption during the first 24 hours. Methods: Following the approval of the Institutional Review Board of An-Najah National University and written informed consent from patients undergoing laparoscopic cholecystectomy, hundred patients between 18 and 60 years old, American Society of Anesthesiologist (ASA) Grades I and II, were randomized to one of the following groups by the sealed envelope: (Mo group) (n=50) receiving intraperitoneal instillation of 30 ml 0.25% bupivacaine and 3 mg morphine and (Mg group) (n=50) receiving intraperitoneal instillation of 0.25% bupivacaine plus 50 mg/kg magnesium sulfate to a total volume of 30 ml. Medications were given after peritoneal wash and suctioning through intraperitoneal instillation. A drug solution is prepared by a doctor who does not participate in the study. All patients received the same anesthesia method, general anesthesia was administered. The induction protocol was standard for all patients. Patients were monitored for electrocardiogram (ECG), heart rate, blood oxygenation (SpO 2 %) and noninvasive blood pressure (NIBP). Postoperative pain was evaluated using visual analog scale (pain score of 0-10). The participants were evaluated for 24 hours after the operation with the registration of abdominal pain. The postoperative pain outcome was reported at 0 and 30 min, 1, 4, 8, 12, 16 and 24 hours. The cutoff value for VAS is 4 for indication of rescue medication. At VAS ≥ 4, rescue analgesics were administered on request (20 mg of pethidine) intravenously in Post Anesthetic Care Unit (PACU) and 50 mg intramuscularly in the surgical ward.
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
Intraperitoneal Bupivacaine as Post-laparoscopic Cholecystectomy Analgesia
Journal of the College of Physicians and Surgeons Pakistan, 2020
Peritoneal cavity irrigation with various local anesthetic drugs for post-LC analgesia has become a very popular practice in past few years. In some studies, highly concentrated bupivacaine in low volumes, i.e. 20ml in 100ml normal saline was used to achieve post-LC analgesia; but the duration of post-operative analgesia was not sufficiently long. 5-8 On the other hand, diluted bupivacaine in huge volumes i.e. 20ml in 500ml normal saline was used to achieve post-LC analgesia and the duration of postoperative was effectively long and depth of analgesia was also adequate. 9 Large volumes can reach all the areas in the sub-hepatic region and produce adequate analgesia, which can be the ultimate reason for promising results in the study, using large volumes of diluted local anesthetic.