Comparative evaluation of subcutaneous infiltration (port site) vs intraperitoneal infiltration of bupivacaine on post laparoscopic cholecystectomy pain

R. S. Gupta, A. Rai, Vikram Vasuniya, Devendra Choudhary


Background: Laparoscopic cholecystectomy (LC) is now the gold standard technique for the treatment of gallstones disease. Although pain after LC is less intense than after open cholecystectomy, some patients still experience considerable discomfort during early postoperative hours. The aim of this study is to evaluate the effect of intraperitoneal and port site instillation of local anaesthetics on pain relief in early postoperative period following LC.

Methods: This is a randomized, prospective analytical study among patients subjected to elective laparoscopic cholecystectomy. Patients were divided into 3 groups as; Group 1 was control, Group 2 was assigned to receive portside infiltration of bupivacaine, while group 3 received combined port site and intraperitoneal instillation of bupivacaine. The evaluation of postoperative pain was done according to the visual analog scale and the dosage of narcotic analgesics consumed and duration of hospital stay was also recorded.

Results: At 1st post-operative hour, minimum VAS score was in group 3 (p=0.003). At 4th post-operative hour, Minimum VAS score was in group 3(p=0.015). At 8th post-operative hour, Minimum VAS score was in group 3, (p=0.044). Patients in group 3 received a lower total amount of rescue analgesia and they also had the shortest hospital stay after LC, compared to the patients in the other groups. As regarding the incidence of right shoulder pain, group 3 has minimal no of patients experienced rt shoulder tip pain.

Conclusions: Infiltration of bupivacaine into port site and intraperitoneal space is simple, inexpensive and effective technique to minimize early postoperative pain and can be practiced for elective LC.


Bupivacaine, Intraperitoneal, Laparoscopic cholecystectomy, Port site, VAS

Full Text:



Johnson CD. ABC of the upper gastrointestinal tract Upper abdominal pain: Gall bladder. Br Med J. 2001;323:11703.

Joris J, Thiry E, Paris P, Weerts J, Lamy M. Pain after laparoscopic cholecystectomy: Characteristics and effect of intraperitoneal bupivacaine. Anesth Analg. 1995;81:379-84.

Papadima A, Lagoudianakis E, Antonakis P, Filis K, Makri I, Markogiannakis H, et al. Repeated intraperitoneal instillation of levobupivacaine for the management of pain after laparoscopic cholecystectomy. Surg. 2009;146:475-82.

Barkun JS, Barkun AN, Sampalis JS, Fried G, Taylor B, Wexler MJ, et al. Randomised controlled trial of laparoscopic versus mini cholecystectomy: a national survey of 4292 hospitals and an analysis of 77604 cases. Lancet. 1992;340:1116-9.

Bisgaard T, Klarskov B, Rosenberg J, Kehlet H. Characteristics and prediction of early pain after laparoscopic cholecystectomy. Pain. 2001;90:261-9.

Fiorillo MA, Davidson PG, Fiorillo M, D’Anna JA, Sithian N, Silich RJ. 149 ambulatory laparoscopic cholecystectomies. Surg Endosc. 1996;10:52-6.

Yeh C, Tsai C, Cheng C, Wang S, Liu Y, Chiang K, et al. Pain relief from combined wound and intraperitoneal local anesthesia for patients who undergo laparoscopic cholecystectomy. BMC Surg. 2014;14:28.

Bisgaard T, Klarskov B, Rosenberg J, Kehlet H. Characteristics and prediction of early pain after laparoscopic cholecystectomy. Pain. 2001;90:261-9.

El-labban GM, Hokkam EN, El-labban MA, Morsy K, Saadl S, Heissam KS. Intraincisional vs intraperitoneal infiltration of local anaesthetic for controlling early post-laparoscopic cholecystectomy pain. J Min Acc Surg. 2011;7(3):173.

Sarac AM, Aktan AO, Baykan N. The effect and timing of local anesthesia in laparoscopic cholecystectomy. Surg Laparosc Endosc. 1996;6:362-6.

Bisgaard T, Kehlet H, Rosenberg J. Pain and convalescence after laparoscopic cholecystectomy. Ann R Coll Surg Engl. 2001;167:84-96.

Liu YY, Yeh CN, Lee HL, Wang SY, Tsai CY, Lin CC, et al. Local anesthesia with ropivacaine for patients undergoing laparoscopic cholecystectomy. World J Gastroenterol. 2009;15:2376-80.

Chari NB. Intraperitoneal bupivacaine instillation for postoperative pain relief after laparoscopic cholecystectomy. Indian J Anaes. 2002;46(1):49-52.

Lepner U, Goroshina J, Samarütel J. Postoperative pain relief after laparoscopic cholecystectomy: A randomised prospective doubleblind clinical trial. Scand J Surg. 2003;92:121-4.

Narchi P, Benhamou D, Fernandez H. Intraperitoneal local anaesthetic for shoulder pain after day case laparoscopy. The Lancet. 1991;338:1569-70.

Pasqualucci A, de Angelis V, Contardo R. Preemptive analgesia: intraperitoneal local anesthetic in laparoscopic cholecystectomy. A randomized, double-blind, placebo controlled study. Anesthesiol. 1996;85:11-20.

Rademaker BM, Kalkman CJ. Intraperitoneal local anesthetics after laparoscopic cholecystectomy: effects on postoperative pain, metabolic responses and lung function. Br J Anaes. 1994;72:263-6.

Rademaker BM, Ringers J, Odoom JA, de WL, Kalkman CJ, Oosting J. Pulmonary function a stress response after laparoscopic cholecystectomy: comparison with subcostal incision and influence of thoracic epidural anaesthesia. Anesthes Analg. 1992;75:381-5.

Scheinin B, Kellokiempu I, Lindgren L, Haglund C, Rosenberg PH. Effect of intraperitoneal bupivacaine on pain after laparoscopic cholecystectomy Acta Anaesthesia Scand. 1995;39:195-8.

Raetzell M, Maier C, Schroder D, Wulf H. Intraperitoneal application of bupivacaine during laparoscopic cholecystectomy risk or benefit?. Anesthes Analg. 1995;81(5):967-72.

Ure BM, Troidl H, Spangenberger W, Neugebauer E, Lefering R, Ullmann K, et al. Preincisional local anesthesia with bupivacaine and pain after laparoscopic cholecystectomy. A doubleblind randomized clinical trial. Surg Endosc. 1993;7:482-8.

Alam MS, Hoque HW, Saifullah M, Ali MO. Port Site and Intraperitoneal Infiltration of Local Anesthetics in Reduction of Postoperative Pain after Laparoscopic Cholecystectomy. Med Today. 2009;22(1):1-28.

Chundrigar T, Morris R, Hedges AR, Starnatakis JD. Intraperitoneal bupivacaine for effective pain relief after laparoscopic cholecystectomy. Annals R coll surg Engl. 1993;75:437-9.

Szem JW, Hydo L. A double blind evaluation of intraperitoneal bupivacaine vs saline for the reduction of postoperative pain and nausea after laparoscopic cholecystectomy. Surg Endos. 1996;10:44-8.

Michaloliakou C, Chung F. Preoperative multimodal analgesia facilitates recovery after ambulatory laparoscopic cholecystectomy. Anaes Anal. 1996;82:44-51.

Cunniffe MG, McAnena OJ, Dar MA, Calleary J, Flynn N. A prospective randomized trial of intraoperative bupivacaine irrigation for management of shoulder tip pain following laparoscopy. Am J Surg. 1998;176:258-61.

Zmora O, StolikDollberg O, BarZakai B, Rosin D, Kuriansky J, Shabtai M, et al. Intraperitoneal bupivacaine does not attenuate pain following laparoscopic cholecystectomy. JSLS. 2000;4:301-4.

Elfberg BA, Sjövall-Mjöberg S. Intraperitoneal bupivacaine does not effectively reduce pain after laparoscopic cholecystectomy: A randomized, placebocontrolled and doubleblind study. Surg Laparosc Endosc Percutan Tech. 2000;10:357-9.

Elhakim M, Elkott M, Ali NM, Tahoun HM. Intraperitoneal lidocaine for postoperative pain after laparoscopy. Acta Anaesthesiol Scand. 2000;44:280-4.