Analgesic effect of intraperitoneal instillation of bupivacaine for postoperative laparoscopic cholecystectomy.

ABSTRACT

OBJECTIVE: To study the effectiveness of intraperitoneal instillation of bupivacaine for postoperative laparoscopic cholecystectomy pain relief, especially specific pain (visceral pain, shoulder pain and epigastric pain). PATIENTS AND METHOD: Eighty ASA (American Society of Anesthesiologists) 1 and 2 patients were randomly assigned to receive either 20 ml of 0.5 per cent bupivacaine (n=39) or the same volume of saline (n=41) instilled under direct vision into the hepatodiaphragmatic space, near and above the hepatoduodenal ligament and above the gall bladder bed at the end of surgery. The intensity of visceral pain, shoulder pain and epigastric pain was assessed at 1, 6, 24 and 48 h after surgery using a visual analogue scale (100 mm VAS) and verbal rating "Prince Henry" pain scale (VRS). The time when analgesia was first required and total analgesic consumption were also recorded. t-test, Chi-square, Mann-Whitney U test and Kaplan-Meier survival analysis were used for statistical analysis. RESULTS: Patient data were similar in the two groups except for body weight. There were no statistical differences between the two groups for the time when analgesia was first' required, VAS, VRS and total analgesic consumption. CONCLUSION: In this study, intraperitoneal instillation of bupivacaine does not show any advantage for postoperative analgesia after laparoscopic cholecystectomy.