Evaluation of superiority of preemptive analgesia with instillation of 0.5% bupivacaine before rather than after surgery for laparoscopic cholecystectomy

Authors

  • Manoj A. Vasava Department of Surgery, Govt. Medical College, Baroda, Gujarat, India
  • Jay M. Makadia Department of Surgery, Govt. Medical College, Baroda, Gujarat, India

DOI:

https://doi.org/10.18203/2349-2902.isj20191875

Keywords:

Laparoscopic cholecystectomy, Preemptive analgesia, Visual analouge score

Abstract

Background: The objective of the study was to evaluate the superiority of preemptive analgesia with instillation of 0.5% bupivacaine before rather than after surgery for laparoscopic cholecystectomy.

Methods: A prospective, randomized study of 264 patients in whom laparoscopic Cholecystectomy (LC) was conducted in the department of General Surgery at the SSG and Medical College Baroda during a period of 25 months from October 2010 to October 2012. Randomization was done with prepared close enveloped which randomly allocate the patient in either group A or B. Data collected from each patient were: age, sex, ASA score, hospital stay, duration of surgery, no of trocar used, first request for analgesics, vomiting, duration of surgery, intraperitoneal drain was kept or not , length of hospital stay, any other postoperative complication.

Results: During the period of 24 months total 264 patients were undergone cholecystectomy. On comparison between Group A and B, data shows that the mean  VAS is less at all assessment (4, 8 & 24 hrs) for Group A as compared to Group B. Mean parietal pain score VAS is less for Group B as compared to Group A at all assessments.

Conclusions: Use of bupivacaine in optimal dose in GB bed reduced the visceral pain and use in skin, SC tissue, muscular tissue reduced the parietal pain. Use of bupivacaine before GB removal is much more cost effective than after removal of GB.

Author Biographies

Manoj A. Vasava, Department of Surgery, Govt. Medical College, Baroda, Gujarat, India

assistant professor,department of surgery

Jay M. Makadia, Department of Surgery, Govt. Medical College, Baroda, Gujarat, India

senior resident, department of surgery

References

Barczynski M, Konturek A, Herman RM, Superiority of preemptive analgesia with intraperitoneal instillation of bupivacaine before rather than after the creation of pneumoperitoneum for laparoscopic cholecystectomy: a randomized, double-blind, placebo-controlled study: Surg Endosc. 2005;20:1088-93.

Maestroni U, Sortini, Devito C, Pour Morad Kohan Brunaldi F, Anania G, et al. A new method of preemptive analgesia in laparoscopic Cholecystectomy: a randomized, double-blind, placebo-controlled study. Surg Endosc. 2002;16:1336-40.

Pascqualucci A, De Angelis V, Contardo R, Colo F, Terrosu G, Donini A, et al. Preemptive analgesia: A randomized, double-blind, placebo-controlled study. Anesthesiol. 1996;85:11-20.

Coughlin SM, Karanicolas PJ, Heather MA, Bilge Kanbur, Savas K, Colquhoun PHD. Better late than never? Impact of local analgesia timing on postoperative pain in laparoscopic surgery: a systemic review and metaanalysis: Surg Endosc. 2010;24:3167-76.

Lee IO, Kim SH, Kong MH. Pain after laparoscopic cholecystectomy: the effect and timing of incisional and intraperitoneal bupivacaine. Can J Anaesth. 2001;48:545-50.

Mixter CG, Hackett TR. Pre-emptive analgesia i the laparoscopic patient. Surg Endosc. 1997;11:351-3.

Moiniche S, Jorgensen H, Wetterslev J, and Dahl JB. Local Anesthetic Infiltration for Postoperative Pain Relief After Laparoscopy. Anesth Analg. 2000;90:899-912.

Kaholkar A, Sammour T, Soop M, Hill AG. Intraperitoneal use of local anaesthetic laparoscopic Cholecystectomy: systematic review and metaanalysis of randomized contolled trials J Hepatobiliary Pancreat Sci. 2010;17:637-56.

Chundrigar T, Hedges AR, Morris R. Intraperitoneal bupivacaine for effective pain relief after laparoscopic cholecystectomy. Ann R Coll Surg Engl. 1993;75:437-9.

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

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

Gerardo Castillo-Garza, MD, Jose´ A. Díaz-Elizondo, MD, Carlos A. Cuello-García, MD,Oscar Villegas-Cabello, MD Irrigation with Bupivacaine at the Surgical Bed for Postoperative Pain Relief After Laparoscopic Cholecystectomy JSLS. 2012; 16:105-11.

Jabbour-Khoury SI, Dabbous AS, Gerges FJ, Azar MS, Ayoub CM, Khoury GS. Intraperitoneal and Intravenous Routes for Pain Relief in Laparoscopic Cholecystectomy JSLS. 2005;9:316-21.

Szem JW, Hydo L, Barie. A double – blinded evaluation of intraperitoneal bupivaciane vs saline for the reduction of post operative pain and nausea after laparoscopic Cholecystectomy. Surg Endosc. 1996;10:44-8.

Raetzell M, Maier C, Schrijder D, Wulf H. Intraperitoneal Application of Bupivacaine During Laparoscopic Cholecystectomy-Risk or Benefit? Anesth Analg. 1995;81:967-72.

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Published

2019-04-29

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Original Research Articles