Intraincisional vs intraperitoneal infiltration of local anaesthetic for controlling early post-laparoscopic cholecystectomy pain

Gouda M El-Labban, Emad N Hokkam, Mohamed A El-Labban, Khaled Morsy, Sameh Saadl, Khaled S Heissam, Gouda M El-Labban, Emad N Hokkam, Mohamed A El-Labban, Khaled Morsy, Sameh Saadl, Khaled S Heissam

Abstract

Background: The study was designed to compare the effect of intraincisional vs intraperitoneal infiltration of levobupivacaine 0.25% on post-operative pain in laparoscopic cholecystectomy.

Materials and methods: This randomised controlled study was carried out on 189 patients who underwent laparoscopic cholecystectomy. Group 1 was the control group and did not receive either intraperitoneal or intraincisional levobupivacaine. Group 2 was assigned to receive local infiltration (intraincisional) of 20 ml solution of levobupivacaine 0.25%, while Group 3 received 20 ml solution of levobupivacaine 0.25% intraperitoneally. Post-operative pain was recorded for 24 hours post-operatively.

Results: Post-operative abdominal pain was significantly lower with intraincisional infiltration of levobupivacaine 0.25% in group 2. This difference was reported from 30 minutes till 24 hours post-operatively. Right shoulder pain showed significantly lower incidence in group 2 and group 3 compared to control group. Although statistically insignificant, shoulder pain was less in group 3 than group 2.

Conclusion: Intraincisional infiltration of levobupivacaine is more effective than intraperitoneal route in controlling post-operative abdominal pain. It decreases the need for rescue analgesia.

Keywords: Laparoscopic cholecystectomy; levobupivacaine; local anaesthetics; postoperative pain.

Conflict of interest statement

Conflict of Interest: None declared.

References

    1. Zacks SL, Sandler RS, Rutledge R, Brown RS. A population-based cohort study comparing laparoscopic cholecystectomy and open cholecystectomy. Am J Gastroenterol. 2002;97:334–40.
    1. Ji W, Ding K, Li LT, Wang D, Li N, Li JS. Outpatient versus inpatient laparoscopic cholecystectomy: A single center clinical analysis. Hepatobiliary Pancreat Dis Int. 2010;9:60–4.
    1. Johansson M, Thune A, Nelvin L, Lundell L. Randomized clinical trial of day-care versus overnight-stay laparoscopic cholecystectomy. Br J Surg. 2006;93:40–5.
    1. Gadacz TR, Talamini MA. Traditional versus laparoscopic cholecystectomy. Am J Surg. 1991;161:336–8.
    1. Kucuk C, Kadiogullari N, Canoler O, Savli S. A Placebo-controlled comparison of bupivacaine and ropivacaine instillation for preventing postoperative pain after laparoscopic cholecystectomy. Surg Today. 2007;37:396–400.
    1. 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.
    1. Lum YW, House MG, Hayanga AJ, Schweitzer M. Postcholecystectomy syndrome in the laparoscopic era. J Laparoendosc Adv Surg Tech A. 2006;16:482–5.
    1. 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. Surgery. 2009;146:475–82.
    1. Bisgaard T, Klarskov B, Rosenberg J, Kehlet H. Characteristics and prediction of early pain after laparoscopic cholecystectomy. Pain. 2001;90:261–9.
    1. Wills VL, Hunt DR. Pain after laparoscopic cholecystectomy. Br J Surg. 2000;87:273–84.
    1. Bisgaard T, Kehlet H, Rosenberg J. Pain and convalescence after laparoscopic cholecystectomy. Eur J Surg. 2001;167:84–96.
    1. Kehlet H, Rung GW, Callesen T. Postoperative opioid analgesia: Time for a reconsideration? J Clin Anesth. 1996;8:441–5.
    1. Jin F, Chung F. Multimodal analgesia for postoperative pain control. J Clin Anesth. 2001;13:524–39.
    1. Louizos AA, Hadzilia SJ, Leandros E, Kouroukli IK, Georgiou LG, Bramis JP. Postoperative pain relief after laparoscopic cholecystectomy: A placebo-controlled double-blind randomized trial of preincisional infiltration and intraperitoneal instillation of levobupivacaine 0.25% Surg Endosc. 2005;19:1503–6.
    1. Gupta A. Local anaesthesia for pain relief after laparoscopic cholecystectomy-a systematic review. Best Pract Res Clin Anaesthesiol. 2005;19:275–92.
    1. Labaille T, Mazoit JX, Paqueron X, Franco D, Benhamou D. The clinical efficacy and pharmacokinetics of intraperitoneal ropivacaine for laparoscopic cholecystectomy. Anesth Analg. 2002;94:100–5.
    1. Papagiannopoulou P, Argiriadou H, Georgiou M, Papaziogas B, Sfyra E, Kanakoudis F. Preincisional local infiltration of levobupivacaine vs ropivacaine for pain control after laparoscopic cholecystectomy. Surg Endosc. 2003;17:1961–4.
    1. Paulson J, Mellinger J, Baguley W. The use of intraperitoneal bupivacaine to decrease the length stay in elective laparoscopic cholecystestomy patients. Am Surg. 2003;69:275–8.
    1. Feroci F, Kröning KC, Scatizzi M. Effectiveness for pain after laparoscopic cholecystectomy of 0.5% bupivacaine-soaked Tabotamp placed in the gallbladder bed: A prospective, randomized, clinical trial. Surg Endosc. 2009;23:2214–20.
    1. Inan A, Sen M, Dener C. Local anesthesia use for laparoscopic cholecystectomy. World J Surg. 2004;28:741–4.
    1. Kim TH, Kang H, Park JS, Chang IT, Park SG. Intraperitoneal ropivacaine instillation for postoperative pain relief after laparoscopic cholecystectomy. J Korean Surg Soc. 2010;79:130–6.
    1. 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;89:1017–24.
    1. 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 double-blind randomized clinical trial. Surg Endosc. 1993;7:482–8.
    1. Bisgaard T. Analgesic treatment after laparoscopic cholecystectomy. Anesthesiology. 2006;104:835–46.
    1. Lepner U, Goroshina J, Samarütel J. Postoperative pain relief after laparoscopic cholecystectomy: A randomised prospective double-blind clinical trial. Scand J Surg. 2003;92:121–4.
    1. Møiniche S, Jørgensen H, Wetterslev J, Dahl JB. Local anesthetic infiltration for postoperative pain relief after laparoscopy: A qualitative and quantitative systematic review of intraperitoneal, port-site infiltration and mesosalpinx block. Anesth Analg. 2000;90:899–912.
    1. Ahmed BH, Ahmed A, Tan D, Awad ZT, Al-Aali AY, Kilkenny J, 3rd, et al. Post-laparoscopic cholecystectomy pain: Effects of intraperitoneal local anesthetics on pain control-a randomized prospective double-blinded placebo-controlled trial. Am Surg. 2008;74:201–9.
    1. Zmora O, Stolik-Dollberg O, Bar-Zakai B, Rosin D, Kuriansky J, Shabtai M, et al. Intraperitoneal bupivacaine does not attenuate pain following laparoscopic cholecystectomy. JSLS. 2000;4:301–4.
    1. Elfberg BA, Sjövall-Mjöberg S. Intraperitoneal bupivacaine does not effectively reduce pain after laparoscopic cholecystectomy: A randomized, placebo-controlled and double-blind study. Surg Laparosc Endosc Percutan Tech. 2000;10:357–9.
    1. Uzunkoy A, Coskun A, Akinci OF. The value of preemptive analgesia in the treatment of postoperative pain after laparoscopic cholecystectomy. Eur Surg Res. 2001;33:39–41.
    1. Lee IO, Kim SH, Kong MH, Lee MK, Kim NS, Choi YS, et al. Pain after laparoscopic cholecystectomy: The effect and timing of incisional and intraperitoneal bupivacaine. Can J Anaesth. 2001;48:545–50.
    1. 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.
    1. 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.
    1. Elhakim M, Elkott M, Ali NM, Tahoun HM. Intraperitoneal lidocaine for postoperative pain after laparoscopy. Acta Anaesthesiol Scand. 2000;44:280–4.

Source: PubMed

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