A comparative study of intra-peritoneal instillation of lignocaine versus placebo on operative site in laparoscopic cholecystectomy

Authors

  • Mukund Mundra Department of General Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
  • Vinod Kumar Department of Urology, Institute of Liver and Biliary Science, Vasant Kunj, New Delhi, India

DOI:

https://doi.org/10.18203/2349-2902.isj20180819

Keywords:

Intraperitoneal local anaesthetic, Laparoscopic cholecystectomy

Abstract

Background: Visceral nociception is a significant source of the post-operative morbidity in Laparoscopic cholecystectomy and thus the idea of intraperitoneal local anaesthetic (IPLA) instillation was promulgated. The aim of the study was to evaluate the role of intra-peritoneal lignocaine instillation on post-operative morbidity in terms of post-operative pain and post-operative nausea and vomiting and also to establish if there is any difference exists between the timing of instillation of intra-peritoneal lignocaine (before and after completing the gall bladder dissection).

Methods: Eighty patients randomized into two groups lignocaine group (lignocaine instilled in gallbladder bed) and placebo group (saline instilled in gallbladder bed). Lignocaine group further divided into subgroups i.e. pre-dissection lignocaine group (lignocaine instilled before gallbladder dissection) and post-dissection lignocaine group (lignocaine instilled after gallbladder dissection).

Results: Post-operative pain was measured in terms of the VAS score. The score was less in lignocaine group. The difference was statistically significant (p<0.05) at 1, 2, 4, 6, 12 and 24hours between lignocaine group and placebo Group. No statistically significant difference between the mean of VAS scores of pre-dissections lignocaine and post-dissection lignocaine subgroups. In lignocaine group, 27.8%, 75%, 41% and 25% of the subject required rescue analgesia in 1st hr, next 1-8 hr, 8-16 hr and 16-24 hr respectively. In placebo group 33.3%, 97.2%, 83.3 % and 63.9% of the subject required rescue analgesia in 1st hr, next 1-8 hr, 8-16 hr and 16-24hr respectively. The difference was found to be statistically significant (p<0.05) except at 1st hour. Post operatively nausea perception, seemed to be slightly higher in placebo group as compared to lignocaine group but difference was statistically insignificant (p>0.05).

Conclusions: Intraperitoneal lignocaine instillation is an effective method to alleviate post-operative pain in patients undergoing laparoscopic cholecystectomy, whether used as pre-emptive analgesia or instilled at the end of surgery. Intraperitoneal lignocaine instillation decreases post-operative analgesia requirement, especially after the 1st post-operative hour.

References

Kelly JE, Burrus RG, Burns RP, Graham LD, Chandler KE. Safety, efficacy, cost, and morbidity of laparoscopic versus open cholecystectomy: A prospective analysis of 228 consecutive patients. Am Surg. 1993;59:23-7.

Kapur PA. The big little problem. Anesth Analg. 1991;73:243-5.

Sample size calculation: Comparison of two means. Available at: https://www.medcalc.org/manual/sampling_comparison_of_two_means.php. Accessed 14 May 2014.

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

Ness TJ, Gebhart GF. Visceral pain: a review of experimental studies. Pain. 1990;41(2):167-234.

Ritchie JM, Strichartz GR. The action of local anesthetics on ion channels of excitable tissues. In: Strichartz GR. Local anesthetics (Handbook of experimental pharmacology). Berlin, Springer-Verlag; 1987:21-53.

Rimback G, Cassuto J, Wallin G, Westlander G. Inhibition of peritonitis by amide local anesthetics. Anesthesiol. 1988;69:881-6.

Yuzbasioglu MF, Ezberci F, Senoglu N. Intraperitoneal EMLA (lidocaine/prilocaine) to prevent abdominal adhesion formation in a rat peritonitis model. Bratisl Lek Listy. 2008;109:537-43.

Nellgard P, Jonsson A, Bojo L. Small-bowel obstruction and the effects of lidocaine, atropine and hexamethonium on inflammation and fluid losses. Acta Anaesthesiol Scand. 1996;40:287-92.

Sammour T, Kahokehr A, Soop M, Hill AG. Peritoneal damage – the inflammatory response and clinical implications of the neuro-humoral axis. World J Surg. 2010;34:704-20.

Fuhrer Y, Charpentier C, Boulanger G. Analgesia after laparoscopic cholecystectomy by intraperitoneal administration of bupivacaine. Ann Fr Anesth Reanim. 1996;15:128-34.

Memedov C, Menteş O, Şimşek A. Comparison of analgesic effects of intraperitoneal lornoxicam and ropivacaine administration in laparoscopic cholecystectomy. Trakya Univ Tip Fak Derg. 2010;27(2):142-9.

Goluboic S, Golubovic V, Tokmadzic VS. Intraperitoneal analgesia for laparoscopic cholecystectomy. Period Biol. 2009;111(2):263-6.

Bhardwaj N, Shgroupa V, Chari P. Intraperitoneal bupivacaine instillation for postoperative pain relief after laparoscopic Cholecystectomy. Indian J Anaesth. 2002;46(1):49-52.

Roberts KJ, Gilmour J, Pande R. Double-blind randomized sham-controlled trial of intraperitoneal bupivacaine during emergency laparoscopic cholecystectomy. Hepatobiliary Pancreat Dis Int. 2013;12:310-6.

Ellabban GM, Hokkam EN, Ellabban MA. Intraincisional vs intraperitoneal infiltration of local anesthetic for controlling early post laparoscopic cholecystectomy pain. J Minim Access Surg. 2011;7(3):173-7.

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

Boddy AP, Mehta S, Rhodes M. The Effect of Intraperitoneal Local Anesthesia in Laparoscopic Cholecystectomy: A Systematic Review and Meta-Analysis. Anesth Analg. 2006;100(3):682-8.

Downloads

Published

2018-02-26

Issue

Section

Original Research Articles