Assessment of Effect of Port Site and Intraperitoneal Instillation of Bupivacaine in Reduction of Post-Operative Pain After Laparoscopic Cholecystectomy

ABSTRACT

Introduction: Effective postoperative pain control is anessential component for care of surgical patients. Inadequatepain control may result in increased morbidity or mortality.Analgesic effects of periportal infiltration of local anesthetics,infiltration of periportal parietal peritoneum, intraperitonealspraying at subdiaphragmatic space and subhepatic spacecovering the area of hepatoduodenal ligament have beenreported. The present controlled study is aimed at assessingthe effect of port site injection and intraperitoneal instillation ofbupivacaine in reduction of post-operative pain afterlaparoscopic cholecystectomy.Materials and Methods: The present study was conductedamong a group of 180 patients diagnosed to have symptomaticcholelithiasis and who underwent elective laparoscopiccholecystectomy under General Anaesthesia. In group 1, preincisional local infiltration of 20ml 0.5% bupivacaine at the portsites and in group 2, local infiltration of 20ml 0.5% bupivacaineat the port sites with intraperitonial installation were given. Ingroup 3, no local infiltration was done and was treated ascontrol group. Pain assessment is based on a Universal PainAssessment Tool. The analysis of our study was performedone way ANOVA & Post HOC test (Scheffe’s HSD) & Chisquare tests as and when indicated.Results: Mean pain scores at 30 minutes were significantlylower in group 1 & 2 compared to control group but howeverthe values were not significantly different when compared toeach other. Similarly the mean pain scores at 4th, 8th, 16th and24th hours for the preincisional and preclosure group, does notsignify any inter group advantage. Therefore, bupivacaineprovide a substantial reduction of pain intensity upto 24 hourspostoperatively and was found to be statistically significant.However, timing of anesthesia was found to be statisticallyinsignificant in terms of preclosure vs pre incisional of the portsites.Conclusion: To conclude, instillation of bupivacaine at the portsites in laparoscopic cholecystectomy irrespective of the timingof instillation is an effective method of achieving pain control inthe post-operative period as long as 24 hours after surgery.There was no statistically significant reduction of post-operativepain between the preincisional and pre closure group.