A prospective observational study: combined irrigation of bupivacaine at the gallbladder fossa with infiltration at port site for postoperative pain relief after laparoscopic cholecystectomy

Abstract

Background: Laparoscopic cholecystectomy is a well-established procedure for gallbladder disease. Pain in laparoscopic cholecystectomy is associated with multiple factors: somatic, visceral, and phrenic nerve irritation. Effective analgesic support should, therefore, be a multimodal approach following laparoscopic surgery for better patient compliance.Methods: A prospective, randomized observational study was undertaken at a tertiary research center for a period of two years (2018-2020). 160 patients undergoing laparoscopic cholecystectomy were chosen and randomized using a computer program into 2 groups. No infiltration was given in the control population. The study group was irrigated with a 0.5% bupivacaine solution (20cc in 30 ml normal saline).Results: The bupivacaine group required fewer analgesics in comparison to the control faction, with less pain at 6 hrs. The timing of oral intake and ambulation were comparable in both factions.Conclusions: Combined bupivacaine use led to a considerable decrease in postoperative pain thereby leading to decreased analgesic use.

Effectiveness of Local Anaesthetic in Reducing Postoperative Pain at Port Site After Laparoscopic Cholecystectomy

“…7 Local tissue infiltration with local anesthetics is one of the simple, yet effective, techniques to prevent and control pain in first 24 hours. This response to intra-peritoneal local anesthetics is mediated by local peritoneal effects rather than by systemic absorption and has a lot of other advantages like simplicity, safety and low cost 8 . Bupivacaine has the longest half life of the generally used local anesthetic drugs in modern-day anesthesia practices.…”

Comparison Between Outcome of Patients Following Saline Irrigation Versus Dry Mopping after Laparoscopic Cholecyetectomy

“…Bile leakage due to rupture of gall bladder contributes to 7% -21.77% 4,5,7 according to most studies with conversion of laparoscopic into open cholecystectomy. Studies showed stone spillage with its retrieval from the fossa of gall bladder can be done by irrigation or be mopping with surgical gauze 7,8 . Study by Rao et al has found 9.34% spilled gall stones intraoperatively due to gall bladder perforation 8 and is avoidable by mopping or irrigation techniques.…”

“…Studies showed stone spillage with its retrieval from the fossa of gall bladder can be done by irrigation or be mopping with surgical gauze 7,8 . Study by Rao et al has found 9.34% spilled gall stones intraoperatively due to gall bladder perforation 8 and is avoidable by mopping or irrigation techniques. Also patients can be monitored postoperatively with signs of persistent pain reported to be 18.64% compared to control group 5.08% in study by Pankaj et al different studies have been done and has found that retrieval of stones is possible in 63% of cases only 9,10 .…”

“…Also patients can be monitored postoperatively with signs of persistent pain reported to be 18.64% compared to control group 5.08% in study by Pankaj et al different studies have been done and has found that retrieval of stones is possible in 63% of cases only 9,10 . Increased surgical site infections 7.1%-11.86% have been seen in patients with spilled stones patients 5,8 .…”