Bupivacaine Instillation into Gallbladder Bed after Laparoscopic Cholecystectomy: Does It Decrease Shoulder Pain?

Abstract

The raw area of the removed organ is at least partially responsible for shoulder pain after laparoscopic cholecystectomy. Local bupivacaine is effective in reducing such pain.

A Study to Evaluate Role of Intraperitoneal Saline Wash for Shoulder Tip Pain Reduction after Laparoscopic Cholecystectomy

“…Thus low pressure pneumoperitoneum and removal of insufflated gas or use of gas drains [12,24,25]. Use of N 2 O, Helium or Argon in place of CO 2 [26] bupivacaine infusion under right hemidiaphragm [27] warm and humified gasless laparoscopy [34]. And in intraperitoneal instillation of normal saline [22,35,36] are some methods that have been studied for reduction of abdominal and shoulder pain after laparoscopic cholecystectomy.…”

“…Use of N 2 O, Helium, Argon, heated gas in place of CO 2 [26]. Bupivacaine infusion under right hemi-diaphragm [27]. There are no standard guidelines to reduce shoulder tip pain.…”

Post-Laparoscopic Cholecystectomy Pain: Effects of Preincisional Infiltration and Intraperitoneal Levobupivacaine 0.25% on Pain Control-a Randomized Prospective Double-Blinded Placebo-Controlled Trial

“…Levobupivacaine given to the subdiaphragmatic region may block the nociceptive stimuli of diaphragmatic peritoneum. In the previous studies, intraperitoneal local anaesthetic application was found to be effective in reducing shoulder pain (12,22,23).…”

“…In the study of Gharaibeh et al (23), in which they compared intraperitoneal 0.25% bupivacaine with placebo in laparoscopic cholecystectomy surgeries, shoulder pain was found to be significantly lower in the group that received local anaesthetics and they reported that application of bupivacaine to gallbladder bed was effective in reducing shoulder pain. Louizos and colleagues (12) reported that 20 mL of levobupivacaine application is effective in decreasing right shoulder pain.…”

Control Del Dolor en La Colecistectomía Laparoscópica Mediante La Aplicación De Bupivacaína en El Lecho De La Vesícula. Hospital Eugenio Espejo-Quito, 2012.

“…Los registros de presión arterial y frecuencia cardíaca no mostraron variabilidad entre los grupos así lo demuestra también otros estudios [16]. No se halló diferencia en la disminución del dolor de hombro, lo que difiere de autores que si encontraron disminución del dolor [17,18,19]. La disminución del dolor postoperatorio a las cuatro, ocho, doce y veinte y cuatro horas fue estadísticamente significativo para el grupo de Bupibacaína en comparación al grupo control, no existió diferencia a las cuarenta y ocho y setenta y dos horas, el mismo que coincide con otras revisiones [17] que con 120 pacientes divididos en seis grupos en donde la instilación intraperitoneal de anestésico local fue estadísticamente significativo para el control de dolor en las primeras 24 horas.…”