RESUMO
BACKGROUND: Although pain after cholecystectomy was reduced significantly since the advent of laparoscopic surgery, many patients still complain of moderate pain after the surgery. Recently intraperitoneal instillation of local anesthetics is known as safe, simple, and effective method of treatment for pain after laparoscopic cholecystectomy. METHODS: Three groups are randomized; group I (normal saline 80 ml), group II (0.5% lidocaine 80 ml+1:400,000 epinephrine) and group III (0.125% bupivacaine 80 ml+1:400,000 epinephrine). Local anesthetics are instilled via subdiaphragmatic trocar hole just after creation of carboperitoneum. Visual analogue scale (VAS), total used analgesics amount, time to first analgesics request, time to out of first flatus and complications are compared. Lidocaine blood concentrations are checked in five cases of the patients after lidocaine instillation. RESULTS: The VAS was insignificant among groups except 3 hr, 6 hr postoperatively. Time to first analgesics request are prolonged in lidocaine and bupivacaine group. Used analgesics amount are significantly less in lidocaine group than control group. Time to out of first flatus was significantly shorter in bupivacaine group. No significant complications were noted. The blood concentration of lidocaine were variable and the highest concentration in five of one case was 1.8 microgram/ml. CONCLUSIONS: Although intraperitoneal instillation of local anesthetics is simple, safe method for controlling pain after laparoscopic cholecystectomy, it is not so much effective because of dilution with irrigating saline and suctioning intraoperatively and postoperative scavenging by evacuator.