Analgesic effect of intraperitoneal methylprednisolone after laparoscopic cholecystectomy

ABSTRACT

This study was designed to compare the analgesic effect of intraperitoneal methylprednisolone alone or combined with bupivacaine to intraperitoneal bupivacaine alone in female patients undergoing elective laparoscopic cholecystectomy. The study included 60 female patients undergoing elective laparoscopic cholecystectomy given a standardized general anaesthetic including fentanyl, propofol, N[2]O, isoflurane, and vecuronium. Patients were randomly allocated into one of three equal sized groups [n=20, each]. Group B intraperitoneal 50ml bupivacaine 0.25% [125mg], group M intraperitoneal 50 ml saline containing 125mg methylprednisolone, and group M+B Intraperitoneal 50ml bupivacaine 0.25% [125mg] + 125mg methylprednisolone. The following parameters were evaluated in all patients 1] Time to first request of analgesia [time elapsed between extubation and first analgesic dose], 2] The incidence and severity of postoperative shoulder and arm pain for 24 hours [the severity of postoperative shoulder and arm pain measured at 0, 6,12,18, and 24h postoperatively using VAS [0-10], 3] The amount of postoperative PCA morphine consumed in 0-6h, 6-12h, 12-18h, I8-24h, and 0-24h following extubation, and 4] Wound healing and infection. Times to first request of analgesia using intravenous morphine in groups B, M, and M+B were 22 [2] min, 10 [1] min, and 23 [1] min respectively. It was significantly short in group M compared to the other 2 groups [p<0.05]. Doses of intravenous PCA morphine consumed at 0-6h, 6-12h, 12-18h, 18-24h, and 0-24h were significantly less in groups M and M+B compared to group B [p<0.05]. There was no significant difference between groups M and M+B. The incidence and severity of shoulder pain were less in group M and M+B compared to group B [p<0.05] with no significant difference between group M and M+B. No apparent adverse effect was seen upon wound healing and infection. Intraperitoneal instillation of methylprednisolone [125mg] alone or in combination with bupivacaine 0.25% [125mg] in female patients undergoing laparoscopic cholecystectomy significantly decreases the postoperative analgesic requirements of intravenous morphine and decreased the incidence of shoulder pain compared to intraperitoneal bupivacaine 0.25% [125mg] alone with no apparent adverse effects upon wound healing and infection