The Effect of 0.5% Bupivacaine Instillation for the Postoperative Pain after Laparoscopic Cholecystectomy / 대한마취과학회지

BACKGROUND: Although post operative pain has been reduced significantly since the advent of laparoscopic surgery, many patients still complain of moderate abdominal and shoulder pain after surgery. METHOD: Patients scheduled for elective laparoscopic cholecystectomy were assigned to three groups by simple randomization(12 patients per group). Group I patients(control) had no specific treatment, group II patients had 10 ml of normal saline instillation, and group III patients had 10 ml of 0.5% bupivacaine instillation. Instillation was made directly into the gallbladder bed and right subdiaphragmatic space under direct vision by the surgeon at the end of the procedure and before evacuating the pneumoperitoneum. RESULT: Compared to that of the group I, VAS of group II and III did not show any statistically significant difference. Compared to the group I, group II & III showed no significant difference in numbers of requests of Tiaprofenic acid during the 36hours after the surgery. CONCLUSION: Topical instillation of 0.5% bupivacaine 10 ml to the gallbladder bed and right subdiaphragmatic space after laparoscopic cholecystectomy is not effective for the post operative pain control.

The Topical Intraperitoneal Anesthesia of 0.5% Bupivacaine Before Laparoscopic Cholecystectomy is Effective on the Postoperative Pain Control / 대한마취과학회지

BACKGROUND: Recently, laparoscopic cholecystectomy becomes more favorite method than traditional open cholecystectomy. But postoperative pain control is still remaining problem. METHOD: Patients scheduled for elective laparoscopic cholecystectomy were assigned to two groups by simple randomization (15 patients per group). Group C (control) had no specific treatment and group B (bupivacaine) received 20 ml of 0.5% bupivacaine with epinephrine 1:200,000 before surgery. Immediately after the creation of a pneumoperitoneum, the surgeon sprayed the bupivacaine near and above the operation field. Operation was started 10 minutes after then. We attempted to investigate that the degree of postoperative pain which was assessed using the visual analogue scale (VAS) and the verbal rating scale (VRS) in the recovery room at postoperative 1 h., as well as the analgesic requirements during the first 24 h. postoperatively. RESULT: VRS of group B was significantly lower than group C (p<0.05), but VAS was not significantly different. Six patients in group B and only one in group C requested no analgesics. Group C had statistically more frequent request for analgesics than group B (p<0.05). CONCLUSION: The topical intraperitoneal anesthesia of 20 ml of 0.5% bupivacaine with epinephrine 1 : 200,000 before laparoscopic cholecystectomy is effective on the postoperative pain control. So, we recommmend that this simple and effective management is routinely treated in patients undergoing laparoscopic cholecystectomy.