Preemptive Analgesia in Laparoscopic Cholecystectomy: A Randomized Controlled Study

Abstract

In pain control after laparoscopic cholecystectomy, subhepatic administration of bupivacaine immediately after the creation of pneumoperitoneum has been shown to be more effective than administration before the withdrawal of the trocars. We aimed to investigate the effect of intraperitoneal bupivacaine administration to the subhepatic area before the creation of the pneumoperitoneum. Eighty patients undergoing elective laparoscopic cholecystectomy under general anesthesia were included in a prospective, randomized study. Patients received 20 mL of 0.5% bupivacaine in the subhepatic area just after intubation, before pneumoperitoneum (group 1), immediately after the creation of the pneumoperitoneum (group 2), just before the removal of the trocars (group 3), or received no local anesthetic (group 4). The degree of the postoperative pain was assessed at 0, 4, 8, 12, and 24 hours after the surgery. The consumption of analgesics (diclofenac sodium) was also recorded. The pain scores and analgesic consumption did not differ among groups 1, 3, and 4. The pain scores of group 2 were lower at each time point compared to the other groups (P < 0.001). Postoperative analgesic consumption in group 2 was reduced compared to the other groups (23.4 +/- 35.9 mg vs. 80.0 +/- 66.3 mg, P = 0.005 [group 1], 69.6 +/- 62.2 mg, P = 0.026 [group 3], and 70.0 +/- 59.9 mg, P = 0.022 [group 4]). The subhepatic infiltration of 20 mL of 0.5% bupivacaine offers good postoperative analgesia when applied just after the creation of the pneumoperitoneum, not before the pneumoperitoneum or after the termination of the pneumoperitoneum.

Preemptive analgesia effects of Ketamine in patients undergoing surgery. A meta-analysis

“…The proposed mechanism of this preemptive effect is that analgesia administered before a nociceptive stimulus reduces the degree of sensitization produced in the nervous system by the stimulus, and facilitates subsequent pain treatment 24 . Therefore, there is reliable theory basis for ketamine as the drug of preemptive analgesia and further studies of ketamine for preemptive analgesia are worth doing.…”

Intraperitoneal Ropivacaine Instillation for Postoperative Pain Relief after Laparoscopic Cholecystectomy

“…(4,(11)(12)(13) Whereas clinicians have investigated beneficial methods to reduce parietal and visceral pains by additive procedures during operation. (2,5,7,9,10,14) In this study we designed a prospective double-blind randomized control study to assess the effect of intraperitoneal ropivacaine instillation during operation and analyze precise pain pattern and opioid amount from computerized patient controlling anesthesia (PCA).…”

Pilot study to assess the safety of local lidocaine injections during endoscopic submucosal dissection for early gastric cancer

“…There were no electrocardiography, heart rate, oxygen saturation, or blood pressure abnormalities recorded, nor were there any episodes of lidocaine intoxication, including respiratory depression or hypotension, convulsion, or arrhythmia, such as cardiovascular collapse or bradycardia. The mean ± SD white blood cell counts and C-reactive protein values on the fi rst post-procedure day were 8700 ± 2100 cells/mm 3 and 0.8 ± 0.7 g/dl, respectively.…”

“…In addition, administering local analgesia for pain during ESD would amount to providing preemptive analgesia for patient pain that might otherwise be experienced the day after the procedure [3].…”