Abstract
Background
This study aimed to determine the character of pain after laparoscopic cholecystectomy and its relief with 0.5% bupivacaine-soaked Surgicel placed in the gallbladder bed.
Methods
For this study, 60 patients with chronic cholecystitis were divided into four groups of 15 each: group A (bupivacaine-soaked Surgicel kept in gallbladder bed), group B (bupivacaine infiltrated at trocar sites), group C (bupivacaine infiltrated into the gallbladder bed and at trocar sites, and group D (normal saline in the gallbladder bed and at trocar sites). Postoperatively, the character of pain was noted, and its relief was assessed with visual analog scale (VAS) scoring.
Results
The findings showed that 78.33% of the patients had visceral pain, 70% experienced parietal, and 23.33% reported shoulder pain after laparoscopic cholecystectomy. The visceral pain was significantly less in the group A patients than in the control subjects (p < 0.05), and none of them experienced shoulder pain. The mean VAS score at 4, 8, and, 24 h in the group A patients also was less than in control group D: 26.37 ± 16.24 versus 38.30 ± 9.51, 23.23 ± 14.28 versus 33.73 ± 7.96, and 18.36 ± 13.00 versus 28.60 ± 9.42, respectively. Trocar-site infiltration alone was not effective in relieving the parietal pain.
Conclusion
Visceral pain is prominent after laparoscopic cholecystectomy and can be effectively controlled by 0.5% bupivacaine-soaked Surgicel in the gallbladder bed alone. Trocar-site infiltration alone is ineffective.
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References
Adams WJ, Avramovic J, Barraclough BH (1991) Wound infiltration with 0.25% bupivacaine is not effective for postoperative analgesia after cholecystectomy. Aust N Z J Surg 61: 626–630
Alexander JL (1997) Pain after laparoscopy. Br J Anesth 79: 369–378
Bisgaard T, Klarskkov B, Kehlet H, Rosenberg J (2003) Preoperative dexamethasone improves surgical outcome after laparoscopic cholecystectomy: a randomized double-blind placebo-controlled trial. Ann Surg 238: 651–660
Chundrigar T, Morris R, Hedges AR, Stamatakis JD (1993) Intraperitoneal bupivacaine for effective pain relief after laparoscopic cholecystectomy. Ann R Coll Surg Engl 75: 437–439
Collins KM, Docherty PWQ, Plantiven OM (1984) Postoperative morbidity following gynecological out patient laparoscopy: a reappraisal of service. Anesthesia 39: 819–822
Edwards ND, Barclay K, Catling SJ, Martin DG, Morgan RH (1991) Day care laparoscopy: a survey of postoperative pain and assessment of the value of diclofenac. Anesthesia 46: 1077–1080
Gharaibeh KI, Ai Jaberi TM (2000) Bupivacaine instillation into gallbladder bed after laparoscopic cholecystectomy: does it decrease shoulder pain? J Laparoendosc Adv Surg Tech 10: 13709
Jorgensen JO, Gillies RB, Hunt DR, Caplehorn JR, Lumley T (1995) A simple and effective way to reduce postoperative pain after laparoscopic cholecystectomy. Aust N Z J Surg 65: 466–469
Joris J, Thiry E, Paris P, Weerts J, Lamy M (1995) Pain after laparoscopic cholecystectomy: characteristics and effect of intraperitoneal bupivacaine. Anesth Analg 81: 379–384
Lepner U, Goroshima J, Samarutel J (2003) Postoperative pain relief after laparoscopic cholecystectomy: a randomized double-blind clinical trial. Scan J Surg 92: 121–124
Mraovic A, Jurisic T, Kogler-Majeric V, Sustic A (1997) Intraperitoneal bupivacaine for analgesia after laparoscopic cholecystectomy. Acta Anesthesiol Scand 41: 193–196
Paulson J, Mellinger J, Baguley W (2003) The use of intraperitoneal bupivacaine to decrease the length of stay in elective laparoscopic cholecystectomy patients. Am Surg 69: 275–278
Peter LW, Roger W, Mary D, Lawrence HB (1989) Biliary duct and gallbladder. In: Gray’s anatomy, 37th ed. Churchill Livingstone, London, pp 1394–1395
Rademaker BM, Kalkman CJ, Odoom JA, Wit LD, Ringers J (1994) Intraperitoneal local anesthetics after laparoscopic cholecystectomy: effect on postoperative pain, metabolic responses, and lung function. Br J Anesth 72: 263–266
Sarac AM, Aktan AO, Baykan N, Yagen C,Yalin R (1996) The effect and timing of local anesthesia in laparoscopic cholecystectomy. Surg Lap Endosc 6: 362–366
Sarli L, Iusko D, Porrini C, Ferro M, Roncordini L (2003) Randomized clinical trial in laparoscopic cholecystectomy performed with mini instruments. Br J Surg 90: 1345–1348
Scheinin B, Kellokumpu I, Lindgren L, Haglund C, Rosenberg PH (1995) Effect of intraperitoneal bupivacaine on pain after laparoscopic cholecystectomy. Acta Anesthesiol Scand 39: 195–198
Schulte-Steinberg H, Weninger E, Jokisch D, Hofstetter B, Misera A, Lange V (1995) Intraperitoneal versus interpleural morphine or bupivacaine for pain after laparoscopic cholecystectomy. Anesthesiology 82: 634–640
Tsimoyianis EC, Glantzounis G, Lekkas ET, Siakas P, Jabarin M, Tzourou H (1998) Intraperitoneal normal saline and bupivacaine infusion for reduction of postoperative pain after laparoscopic cholecystectomy. Surg Laparosc Endosc PCT 8: 416–420
Ure BM, Troidl H, Spangenberger W, Neugebauer E, Lefering R, Ullman K, Benede J (1993) Pre-incisional local anesthesia with bupivacaine and pain after laparoscopic cholecystectomy: a double-blind randomized clinical trial. Surg Endosc 7: 482–488
Ure BM, Troidl H, Spangenberger W, Dietrich E, Lefering R, Neugebauer E (1994) Pain after laparoscopic cholecystectomy: intensity and localization of pain and analysis of predictors in preoperative symptoms and intraoperative events. Surg Endosc 8: 90–96
Weber A, Munoz J, Garteiz D, Cueto J (1997) Use of subdiaphragmatic bupivacaine instillation to control postoperative pain after laparoscopic surgery. Surg Laparosc Endosc PCT 7: 6–8
Acknowledgment
The authors gratefully acknowledge the assistance of their statistician, Mr. R. C. Goel, for analyzing the data and for his valuable comments.
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Verma, G.R., Lyngdoh, T.S., Kaman, L. et al. Placement of 0.5% bupivacaine-soaked Surgicel in the gallbladder bed is effective for pain after laparoscopic cholecystectomy. Surg Endosc 20, 1560–1564 (2006). https://doi.org/10.1007/s00464-005-0284-5
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DOI: https://doi.org/10.1007/s00464-005-0284-5