combination of infiltrative bupivacaine with low-pressure laparoscopy reduces postcholecystectomy pain. a prospective randomized controlled study

ABSTRACT

To evaluate the efficacy of combined infiltrative bupivacaine with low intraperitoneal pressure insufflation in reducing the post-laparoscopic pain in patients undergoing laparoscopic cholecystectomy [LC]. This randomized prospective single-blind study included 473 patients undergoing LC. The study took place at University Hospital Center [Mother Teresa,] Tirana, Albania between January 2006 to September 2009. The patients were divided in 4 groups Group 1 [n=120] with intra-abdominal insufflation pressure 15 mm Hg and no infiltrative bupivacaine [HPNBG]; Group 2 [n=122] with intra-abdominal insufflation pressure 15 mm Hg and with 5 ml infiltrative bupivacaine 0.5% in abdominal minincisions [HPBG]; Group 3 [n=l 10] with intra-abdominal insufflation pressure under 10 mm Hg and no infiltrative bupivacaine [LPNBG]; and Group 4 [n=121] with intra-abdominal insufflation pressure under 10 mm Hg and infiltrative bupivacaine [LPBG]. There were statistically significant differences [p=0.003] between groups regarding incisional pain intensity, between LPBG and HPNBG [p=0.001], between LPBG and HPBG [p=0.037], between LPBG and LPNBG [p=0.001[, as well the shoulder-tip pain intensity [p=0.001]; between LPBG and HPNBG [p=0.001], between LPBG and HPBG [p=0.001], and between LPBG and LPNBG [p=0.031[. We found statistically significant differences related to pain beginning time [ANOVA test, p=-0.027]; between LPBG and HPNBG [p=0.04l], between LPBG and HPBG [p=0.031], and between LPBG and LPNBG [p=0.05]. The combination of infiltrative bupivacaine with low intraperitoneal pressure insufflation shows to be more efficient in reducing the post-laparoscopic pain, compared with other regimens