Effect of bupivacaine soaked gauze in postoperative pain relief in laparoscopic cholecystectomy: a prospective observational controlled trial in 120 patients

Abstract

BackgroundSymptomatic gallstone disease is one of the most common problem attended by a general surgeon. The application of minimally invasive surgical techniques for the removal of gallbladder is now an accepted and preferred method for treating this condition. The avoidance of a subcostal incision and minimal bowel handling leads to decreased postoperative pain, early returning to function and overall shorter duration of hospital stay. Nevertheless, patients do have significant postoperative pain, and newer techniques to further reduce this pain are the subject of many ongoing studies. Many intraoperative techniques for reducing postoperative pain have been described. The current practice at many institutions, including ours, is to discharge the patient on the first postoperative day on oral analgesics. Better control of postoperative pain may help establishing laparoscopic cholecystectomy as a day care procedure in selected patients. The aim of this study is to determine the effect of 0.5 % bupivacaine soaked oxidized regenerated cellulose surgical versus normal saline soaked surgical applied at the gallbladder bed on postoperative mean pain score after laparoscopic cholecystectomy for symptomatic gallstones.Patients and methodsPatients scheduled for laparoscopic cholecystectomy were enrolled in the study after meeting the inclusion criteria. Relevant history was taken and clinical examination was done. Necessary investigations were carried out. All patients were divided to receive either 0.5 % bupivacaine soaked surgicel or normal saline soaked surgicel after laparoscopic cholecystectomy with each group having equal number of patients. The pain score was measured with a visual analogue scale (VAS) at 4, 12 and 24 h after the procedure in both groups. All data was recorded on performa and SPSS-19 was used for analysis.ResultsThe demographic characteristic of the two groups has shown that studied patients were matched as regarding gender, age, weight, ASA status and duration of surgery. Post-operative abdominal pain was significantly lower in bupivacaine Group than Saline group. This difference was reported from 4 h till 12 h post-operatively. Bradycardia, Hypotension and Urinary retention were the most common perioperative symptoms reported, with an incidence of 28.3 % in the saline Group and 15 % in the bupivacaine group with no significant differences. Evaluation of postoperative details such as oral intake, time to walk and length of hospital stay revealed that bupivacaine group reported better outcomes as compared to saline group.ConclusionPlacing bupivacaine soaked surgicel has been shown to decrease the mean postoperative pain score in patients. No significant complication was noticed with the use of surgicel. Because adequate pain control requires intravenous medications, additional methods for pain control need to be studied before laparoscopic cholecystectomy can be routinely performed as a day care case.

Glisson’s capsule cauterisation is associated with increased postoperative pain after laparoscopic cholecystectomy: a prospective case–control study

“…8 Other studies have stated that the largest component in abdominal pain is formed by the parietal peritoneum, which is derived from the incision site, followed by pneumoperitoneum and surgical procedures such as cholecystectomy. 7,12 Pain caused by the surgical incision has been thought to be the most important component and has been shown to be more intense than visceral pain during the first 48 hours after laparoscopic cholecystectomy. 13 Although some studies have shown that injection of a local anaesthetic agent to trocar entry sites does help pain relief, other studies did not attempt to show a positive association with regard to pain relief and have suggested that parietal pain does not contribute substantially to the total pain.…”

“…Shoulder pain is frequent in the postoperative period, and is thought to be related to residual carbon dioxide. 6,7 Studies of pain mechanisms are usually based on somatic rather than visceral nociception. However, more complications are associated with accessing visceral structures, with adequate visceral stimuli studied in research models.…”

Comparison of Intra-Peritoneal Instillation of Bupivacaine and Morphine Hydrochloride versus Bupivacaine and Magnesium Sulfate for Post-Operative Pain Relief after Laparoscopic Cholecystectomy, A Randomized Double-Blind Comparison Study

“…A symptomatic gallstone disease is one of the prevailing problems seen in clinical practice [1]. Surgical removal of the gall bladder can be done laparoscopic or open cholecystectomy [2].…”

“…Progressive manner to further reduce this pain are the subject of many ongoing studies. Intraoperative and postoperative techniques for diminishing postoperative pain have been expressed [1]. Better control of postoperative pain can benefit L.C.…”

“…as a procedure for day care and avert further complications. On-going practice for many institutions, including ours, is to release the patient on the first postoperative day [1].…”