Efficacy of intraperitoneal local anaesthetic techniques during laparoscopic cholecystectomy
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Pain following laparoscopic cholecystectomy (LC) is a barrier to early discharge. Some studies have demonstrated that local anaesthetic (LA) washed over the liver and gallbladder decreases postoperative pain. In many patients pain is partially of diaphragmatic origin which may not be treated effectively by topical wash. This study assesses the efficacy of LA injected to the peritoneum of the right hemidiaphragm or topical wash with a control group.
We performed a double-blind randomized sham controlled trial of 128 consecutive subjects who underwent elective LC. Patients received subcutaneous bupivacaine, a diaphragmatic injection of bupivacaine or sham, and topical wash over the liver/gallbladder with bupivacaine or sham depending upon allocation. The primary outcome was VAS pain scores on the ward. Secondary outcomes included VRS pain scores in theatre recovery, analgesic use, physiological observations, time to eating and ambulation, and successful day-case surgery.
Pain scores were significantly lower in both LA groups versus control in theatre recovery but only in the subperitoneal diaphragm injection group when the patients returned to the ward. Subperitoneal diaphragm injection was associated with a reduced time in theatre recovery (p = 0.04).
Intraperitoneal techniques of LA during LC decrease postoperative pain and shorten time in theatre recovery. Injection of LA to the right hemidiaphragm is associated with lower pain scores for a longer period following LC than a previously validated wash technique.
KeywordsLaparoscopic cholecystectomy Local anaesthetic Pain score Bupivacaine Day-case surgery
The authors kindly thank the following for assistance with data collection: Jenny Abrahms, John O’Callaghan, Ruth DeSouza, Damian Mayo, Sobath Premaratne, and Chris Thompson, and Dr. B Murthy for assistance with the anaesthetic and analgesic regimes/protocols. Dr. P. Nightingale and Mr J. Hodson, medical statisticians, University Hospitals Birmingham NHS, UK, both provided an independent assessment of the data and provided assistance with statistical analysis. The trial’s registration number is NCT01090882 (www.clinicaltrials.gov).
Drs. Roberts, Gilmour, Pande, Nightingale, Tan, and Khan have no conflicts or interest or financial ties to disclose.
Supplementary material 1 (WMV 4846 kb)
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