EFFECTIVENESS OF LOCAL ANAESTHETIC IN REDUCING POSTOPERATIVE PAIN AT PORT SITE AFTER LAPAROSCOPIC CHOLECYSTECTOMY
AbstractBackground: Laparoscopy has become the highest quality level way to deal with cholecystectomy since its inception 30 years preceding, and is perhaps the most normally performed general surgeries. Pain being a significant issue after laparoscopic cholecystectomy bringing about extended admissions or readmissions. With significant varieties in pain relieving conventions an integrated approach is important to diminish pain. The aim of this study is to assess the effectiveness of Bupivacaine as local anesthetic agent at port sites after laparoscopic cholecystectomy. Methods: Study population of 84 patients was divided into control group (receiving no local anesthetic) and study group (receiving Bupivacaine as local anesthetic). Visual analogue scale was used to quantify and compare pain perceived by each group; at fixed intervals of 6, 12 and 24 hours after shifting of the patients back to the ward. Results: Each group comprised 42 patients. At 6 hours post operative pain score in study group, 4.5±0.32 was significantly lower than in control group, 7.6±0.41 (p<0.05). Though pain assessments at 12 and 24 hours didn’t reveal any significant differences among the two groups; postoperative requirement of Tramadol was significantly (p<0.05) lower in study group (92±0.064mg) in comparison to control group (158±0.21mg). Conclusion: Use of long-acting local anesthetic injections at port sites after laparoscopic cholecystectomy significantly lowers pain during first 6 hours post operatively and also lowers narcotic analgesics requirements during post operative period.
Litynski GS. Erich Mühe and the rejection of laparoscopic cholecystectomy (1985): a surgeon ahead of his time. JSLS 1998;2(4):341–6.
Hussain T, Riaz M, Wani AH. Comparative Clinical Evaluation of Early Post Operative Pain with and Without Port Site Local Anaesthetic Infiltration during Laparoscopic Cholecystectomy. IOSR J Dent Med Sci 2019;18(11)31–4.
Barazanchi AW, MacFater WS, Rahiri JL, Tutone S, Hill AG, Joshi GP, et al. Evidence-based management of pain after laparoscopic cholecystectomy: a PROSPECT review update. Br J Anaesth 2018;121(4):787–803.
Strasberg SM. Tokyo Guidelines for the Diagnosis of Acute Cholecystitis. J Am Coll Surg 2018;227(6):624.
Roy N. Assessment of Effect of Port Site and Intraperitoneal Instillation of Bupivacaine in Reduction of Post-Operative Pain After Laparoscopic Cholecystectomy. J Anaesth Surg Res 2019;1(1):1–10.
Akter B, Bahar AA, Ahmed J, Islam MT, Zana K, Alam MR, et al. Port-site infiltration of bupivacaine in reduction of postoperative pain after laparoscopic cholecystectomy. Int J Surg 2021;5(2):135–8.
Gupta RS, Rai A, Vasuniya V, Choudhary D. Comparative evaluation of subcutaneous infiltration (port site) vs intraperitoneal infiltration of bupivacaine on post laparoscopic cholecystectomy pain. Int Surg J 2018;5(2):500–6.
Paliwal P, Huda T, Anand K, Shivani M, Mishra N. A prospective observational study: combined irrigation of bupivacaine at the gallbladder fossa with infiltration at port site for postoperative pain relief after laparoscopic cholecystectomy. Int Surg J 2020;7(10):3340–3.
Barash PG, Cullen BF, Stoelting KR, Cahalan M, Stock C, Ortega R. Clinical anesthesiology. In: Lin Y, Liu SS, editors. Local Anesthetics. 7th ed. New York: Lippincott Williams, 2013; p.561–82.
Bano N, Hayat N, Saleem S, Javaid F, Rehman A, Jabeen M. Comparison of intraincisional and intraperitoneal infiltration of local anaesthetic in laparoscopic cholecystectomy to control early postoperative pain. Prof Med J 2021;28(2):192–6.
Kim TH, Kang H, Park JS, Chang IT, Park SG. Intraperitoneal ropivacine instillation for postoperative pain relief after laparoscopic cholecystectomy. J Korean Surg Soc 2010;79:130–6.
Moiniche S, Jorgensen H, Wetterslev J, Berg J. Local anaesthetic infiltration for postoperative pain relief after laparoscopy: a qualitative and quantitative systematic review of intraperitoneal, port-site infiltration and mesosalpinx block. Anaesth Analg 2000;90:899–912.
Gulzar MR, Farooq U, Akram M. Effect of port site bupivacaine infiltration on post operative parentral analgesic requirement in early post operative period after laparoscopic cholecystectomy. J Univ Med Dent Coll 2019;10(1):16–20.
Chari NB. Intraperitoneal bupivacaine instillation for postoperative pain relief after laparoscopic cholecystectomy. Indian J Anaesth 2002;46(1):49–52.
Nazir AK, Merdan I. Port site infiltration of local anesthetic in reduction of post-operative pain after laparoscopic cholecystectomy. Bas J Surg 2014;20:17–22.
Hanna RS, Nashed GA, Ashraf AH, Makhlouf GA, Said EZ, Abdelraouf AM. The Effectiveness of Combined Wound and Intraperitoneal Local Anesthesia as Pain Relief in Laparoscopic Cholecystectomy: Prospective Case Control Study. Kasr El Aini J Surg 2018;19(2):59.
Cantore F, Boni L, Di Giuseppe M, Giavarini L, Rovera F, Dionigi G. Pre-incision local infiltration with levobupivacaine reduces pain and analgesic consumption after laparoscopic cholecystectomy: a new device for day-case procedure. Int J Surg 2008;6:S89–92.
Bisgaard T, Klarskov B, Kristiansen VB, Callesen T, Schulze S, Kehlet H, et al. Multi-regional local anesthetic infiltration during laparoscopic cholecystectomy in patients receiving prophylactic multi-modal analgesia: a randomized, double-blinded, placebo-controlled study. Anesth Analg 1999;89(4):1017–24.
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