Intraperitoneal Analgesia Instillation for Postoperative Pain Relief after Laparoscopic Cholecystectomy PC10-PC13
Dr. Sandeep Ghosh,
Senior Resident Doctor, Pine Mount Ridge, European Ward, Shillong-793001, Shillong, Meghalaya, India.
Introduction: Laparoscopic Cholecystectomy (LC) has numerous benefits over the open method; still postoperative pain remains an issue. Postoperative pain, requiring injectable analgesics prolong the patient’s hospital stay, and is one of the hurdles in performing LC as a day-case surgery.
Aim: To assess the analgesic effect of Intraperitoneal (IP) administration of Inj. Bupivacaine± Inj. Tramadol in patients undergoing LC.
Materials and Methods: A total of 100 patients scheduled for LC were enrolled in the study after meeting the inclusion criteria. Patients were randomly divided into 3 groups. Patient allocated to Group A received 30 mL of inj. normal saline IP, Group B received 30 mL of 0.25% inj. bupivacaine and Group C received 30 mL of 0.25% inj. bupivacaine along with 100 mg inj. tramadol. The local anaesthetic/analgesic or placebo solution was sprayed on the upper surface of the liver and on right subdiaphragmatic space and over gall bladder bed. The pain intensity of pain for patients in all the three groups were recorded using VAS at 0, 1, 2, 6, 12 and 24 hours after surgery. The student t-test was used to compare mean pain score between groups. The p-value =0.05 was taken as significant.
Results: There was statistically significant difference in postoperative pain intensity in group A vs groups B (p <0.0001) and also between group A vs group C (p <0.0001) during the first 6 hours postoperatively. But the difference in VAS scores between groups B and C were not statistically significant at all times of postoperative recordings. The addition of inj. tramadol to inj. bupivacaine (group C) IP did not cause a significant reduction in pain compared to bupivacaine only group(group B) but there was increased incidence of Post Operative Nausea and Vomiting (PONV) noted in group C as compared to group B.
Conclusion: IP inj. bupivacaine may be used routinely in LC as a part of day-case surgery leading to adequate postoperative pain relief, decreasing need for analgesia and opioids which may lead to early ambulation and initiation of oral feeds, leading to faster postoperative recovery and hence shorter hospital stay, thereby decreasing the burden both to the patient as well as to the hospital.