Laparoscopic cholecystectomy pain: effects of the combination of incisional and intraperitoneal levobupivacaine before or after surgery

Abstract

Özet Amaç SummaryObjectives: We aimed to investigate whether the timing of administration, using a combination of incisional and intraperitoneal levobupivacaine (0.25%), has an effect on the postoperative pain after laparoscopic cholecystectomy in a prospective, randomized, and controlled study. Methods: Sixty six patients were allocated to one of the three groups. Group BS received levobupivacaine before trocar site incision and intraperitoneal levobupivacaine immediately after pneumoperitoneum. Group AS received intraperitoneal levobupivacaine before trocars were withdrawn and incisional levobupivacaine administered at the end of surgery. Group C received no treatment. Data of intraoperative variables, postoperative pain relief, rescue analgesic consumption, and patient satisfaction were compared. Results: The intraoperative fentanyl consumption was found lower in Group BS, compared to Groups AS and C (p<0.05). VAS scores were lower in both Groups BS and AS, compared to Group C immediately after the operation (p<0.05). VAS scores were significantly decreased during the first two hours in Group AS, compared to Group C. The mean doses and number of patients needing rescue meperidine were lower in Group AS, compared to the Groups BS and C (p<0.05). Conclusion:The combination of incisional and intraperitoneal levobupivacaine administered before or after surgery can reduce postoperative pain and analgesic and antiemetic consumption together with improved patient satisfaction. However, administering levobupivacaine before surgery might be advantageous for less intraoperative fentanyl consumption, while levobupivacaine after surgery is advantageous for less postoperative rescue analgesic requirement.

Efficacy of Intraperitoneal Bupivacaine on Pain Relief After Laparoscopic Cholecystectomy

“…Administering levobupivacaine before surgery might be advantageous for less intraoperative fentanyl consumption, while levobupivacaine after surgery is advantageous for less postoperative rescue analgesic requirement. [3] Morsy at al., in his study included 80 patients scheduled for LC, divided into three groups. Group C received 50 ml normal saline intraperitoneally; Group L received 200 mg lidocaine intraperitoneally; and Group N received 10 mg nalbuphine intraperitoneally in 50 ml normal saline.…”

“…This can prolong hospital stay, which is particularly of utmost importance since many centers are performing this operation as a day-case procedure. [3] Postoperative pain management remains a major challenge after laparoscopic procedures. Effective pain control encourages early ambulation, which significantly reduces the risk of deep vein thrombosis and pulmonary embolism (PE); enhances patient's ability to take deep breaths to decrease the risk of pulmonary complications (e.g., atelectasis and pneumonia); and decreases the incidence of tachycardia and unnecessary investigations related to it.…”

The Use of Local Anesthesia for Relief of Postoperative Pain After Laparoscopic Cholecystectomy

“…aparoscopic cholecystectomy (LC) is considered the standard technique to remove symptomatic gall bladder (1) . The pain, which happened after this technique is less and shorter than that caused by open cholecystectomy (2,3) .…”

“…The comparison in means of VAS score of pain between study groups postoperatively at abdominal level are shown in table (2). The means of VAS score after 1, 2, 4, 6, and 12 hrs.…”

Enriched view of postcholecystectomy syndrome: Nowadays and in former times

“…• Incisional port site hernias usually at umbilicus port [15] • Slipped gallstones in the abdominal cavity [16] • Complications of the pneumoperitoneum [17,18] • Clip migration [19] • Painful scars in port-sites [20] Discussion PCS affects approximately 10%-15% of the patients and seems to have age and sex differences. The incidence of PSC is 43% in patients aged 20 to 29 years, 27% in those aged 30 to 39 years, 21% in the 40 to 49 years group, 26% in the 50 to 59 years group and 31% among those aged 60 to 69 years; it does not seem to manifest in patients older than 70 years.…”