Irrigation with Bupivacaine at the Surgical Bed for Postoperative Pain Relief After Laparoscopic Cholecystectomy (original) (raw)
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Patient Safety in Surgery, 2015
Background: Symptomatic gallstone disease is one of the most common problem attended by a general surgeon. The application of minimally invasive surgical techniques for the removal of gallbladder is now an accepted and preferred method for treating this condition. The avoidance of a subcostal incision and minimal bowel handling leads to decreased postoperative pain, early returning to function and overall shorter duration of hospital stay. Nevertheless, patients do have significant postoperative pain, and newer techniques to further reduce this pain are the subject of many ongoing studies. Many intraoperative techniques for reducing postoperative pain have been described. The current practice at many institutions, including ours, is to discharge the patient on the first postoperative day on oral analgesics. Better control of postoperative pain may help establishing laparoscopic cholecystectomy as a day care procedure in selected patients. The aim of this study is to determine the effect of 0.5 % bupivacaine soaked oxidized regenerated cellulose surgical versus normal saline soaked surgical applied at the gallbladder bed on postoperative mean pain score after laparoscopic cholecystectomy for symptomatic gallstones. Patients and methods: Patients scheduled for laparoscopic cholecystectomy were enrolled in the study after meeting the inclusion criteria. Relevant history was taken and clinical examination was done. Necessary investigations were carried out. All patients were divided to receive either 0.5 % bupivacaine soaked surgicel or normal saline soaked surgicel after laparoscopic cholecystectomy with each group having equal number of patients. The pain score was measured with a visual analogue scale (VAS) at 4, 12 and 24 h after the procedure in both groups. All data was recorded on performa and SPSS-19 was used for analysis. Results: The demographic characteristic of the two groups has shown that studied patients were matched as regarding gender, age, weight, ASA status and duration of surgery. Post-operative abdominal pain was significantly lower in bupivacaine Group than Saline group. This difference was reported from 4 h till 12 h post-operatively. Bradycardia, Hypotension and Urinary retention were the most common perioperative symptoms reported, with an incidence of 28.3 % in the saline Group and 15 % in the bupivacaine group with no significant differences. Evaluation of postoperative details such as oral intake, time to walk and length of hospital stay revealed that bupivacaine group reported better outcomes as compared to saline group. Conclusion: Placing bupivacaine soaked surgicel has been shown to decrease the mean postoperative pain score in patients. No significant complication was noticed with the use of surgicel. Because adequate pain control requires intravenous medications, additional methods for pain control need to be studied before laparoscopic cholecystectomy can be routinely performed as a day care case.
Canadian journal of surgery. Journal canadien de chirurgie, 1999
To determine if intraoperative instillation of bupivacaine would decrease early postoperative pain after laparoscopic cholecystectomy, if the patients would consequently require less narcotic postoperatively and if such patients would elect to be discharged on the day of operation if given the choice. Double-blind, randomized, controlled trial. A tertiary care hospital in Hamilton, Ont. Fifty patients underwent laparoscopic cholecystectomy. Day-surgery patients had the choice of staying overnight for discharge the following day. They were compared with a control group of 47 patients who had laparoscopic cholecystectomy but did not receive bupivacaine. Instillation of 20 mL of 0.5% bupivacaine with epinephrine into laparoscopic cholecystectomy port sites intraoperatively before closure. Visual analogue scale (VAS) pain scores assessed 4 times postoperatively, the choice of patients to leave hospital the same day or to remain in the hospital overnight; the level of postoperative narco...
Surgery Journal, 2022
Gallstones in western countries are primarily composed of cholesterol. However, mixed or pigment stones, which contain a higher proportion of bilirubin, are more frequently seen in developing nations and Asia than in western countries. Abdominal and shoulder tip pains (STPs) are common complaints following the standard laparoscopic cholecystectomy procedure. To date, all pain management modalities have proven variable outcomes. This prospective randomized study included 82 patients who underwent elective laparoscopic cholecystectomy. The control group received 20 mL of normal saline, whereas the study group received a 20-mL instillation of 0.5% bupivacaine at the gallbladder bed after surgical resection. The Visual Analog Scale (VAS) was used to analyze abdominal pain and STP. The mean age ranged from 20 to 80 years. Abdominal VAS at 6, 12, 18, 24, 30, 36, and 48 hours were statistically insignificant. The majority were discharged on postoperative day 1 (32 studies, 37 control). Follow-up VAS after 1 week for STP VAS and abdominal pain VAS in both groups were statistically insignificant. Even with small numbers of a well-conducted randomized trial, we demonstrated that bupivacaine irrigation at the gallbladder bedpost laparoscopic cholecystectomy does not affect pain relief.
International Surgery Journal
Background: The aim of this study was to compare the efficacy of infiltration of local anaesthetic bupivacaine at incision site (port site) and intraperitoneally on postoperative pain in patients undergoing laparoscopic cholecystectomy.Methods: This was a randomized controlled study carried out on patients undergoing laparoscopic cholecystectomy. The patients were divided into three groups of 60 patients each. Group 1 was the control group which did not receive either intraincisional or intraperitoneal bupivacaine. Group 2 received intraincisional bupivacaine 0.25% 20 ml, while group 3 received 20 ml solution of bupivacaine 0.25% 20 ml intraperitoneally. Postoperative pain was recorded for 24 hours post-operatively.Results: The incidence of abdominal pain was significantly lower in the group which received intraincisional bupivacaine upto 12 hours postoperatively. Right shoulder pain was low in group receiving intraperitoneal bupivacaine as compared to group 2, but it was not stat...
Intraperitoneal bupivacaine does not attenuate pain following laparoscopic cholecystectomy
JSLS: Journal of the …, 2000
Background: Laparoscopic cholecystectomy is characterized by a short hospital stay. Hence, pain control on the day of surgery is increasingly important. The aim of this study was to evaluate the effect of intraperitoneal bupivacaine on pain relief following laparoscopic cholecystectomy. Methods: Sixty patients undergoing elective laparoscopic cholecystectomy were prospectively randomized into 2 groups. Following removal of the gallbladder, group A received 100 mg of bupivacaine in 50 cc of saline, installed into the gallbladder bed and right subphrenic space. Group B received saline without bupivacaine. Pain was assessed using a visual/analog scale at fixed-time intervals. Results: No significant difference occurred in the average pain levels between the groups at 1, 2, 4, and 14 hours postsurgery. The average analgesic requirement was lower in the bupivacaine group, but this did not reach statistical significance. Conclusion: Application of intraperitoneal bupivacaine did not attenuate pain following laparoscopic cholecystectomy, and no role exists for its routine use.
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
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...
2021
Background: Port site pain remains prevalent complaint of early postoperative period after laparoscopic cholecystectomy. Objectives: to see the analgesic efficacy of port-site infiltration of bupivacaine in laparoscopic cholecystectomy. Methodology: This randomized controlled clinical trial was conducted in the Department of Surgery, Sylhet MAG Osmani Medical College Hospital, Sylhet from September 2017 to March 2018. Sixty patients underwent laparoscopic cholecystectomy were randomized into experimental group and control group by odd and even number respectively. Infiltration of 0.5% bupivacaine was at port sites subcutaneously in experimental group and none in control group. Postoperative pain intensity was measured using Numeric Rating Scale (NRS) at 6, 12, 24 and 48 hours. Results: Pain score was lesser in experimental group compared to control group at 6, 12, 24 and 48 hours (p< 0.001). The amount of opioid analgesic needed (p=0.006) and hospital stay (p=0.048) were signific...
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.
International Journal of Research in Medical Sciences, 2016
Background: Pain following laparoscopic surgery is multifactorial, arising from trocar sites (somatic pain), operative site (visceral pain) and shoulder pain (referred from diaphragmatic irritation because of pneumo-peritoneum). Currently no standard of care exists to reduce post-operative pain by use of local analgesia in laparoscopic cholecystectomy. Despite many studies, there are contradictory results. Aim of the study was to assess whether instillation of local anaesthetics at trocar sites and intraperitoneally, reduces the amount of pain experienced in the immediate postoperative period after laparoscopic cholecystectomy. Methods: This prospective study was carried out in the Department of General Surgery in a tertiary medical Centre in Mumbai. 75 subjects were randomized into 2 groups. Group A consisting of 38 patients were subjected to multisite instillation of LA combination (bupivacaine+xylocaine) at trocar site, gall bladder fossa, sub diaphragmatic space. Group B, (control group) consisting of 37 patients was given no such LA. Post operatively, pain was assessed by VAS scale (0-100) at 1,4,24 hours. Both the groups were compared and analysed. Results: Group A showed significantly reduced pain scores at 1, 4 and 24 hours post operatively as compared to group B. Conclusions: Our results indicate that multisite infiltration of local anesthetic combination (bupivacaine+xylocaine) after laparoscopic cholecystectomy surgery significantly reduces pain at 1, 4 and 24 hours postoperatively.