scholarly journals Port Site and Intraperitoneal Infiltration of Local Anesthetics in Reduction of Postoperative Pain after Laparoscopic Cholecystectomy

1970 ◽  
Vol 22 (1) ◽  
pp. 24-28 ◽  
Author(s):  
Mohammad Shaha Alam ◽  
Hasnat Waheedul Hoque ◽  
Mohammad Saifullah ◽  
Md Omar Ali
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Pain ◽  
Open Cholecystectomy ◽  
Early Postoperative Period ◽  
Port Site ◽  
Control Group ◽  
Time Interval ◽  
Narcotic Analgesics ◽  
Pain Scores ◽  
Elective Laparoscopic Cholecystectomy

Laparoscopic cholecystectomy is now the gold standard technique for the treatment of gallstones disease. Although pain after laparoscopic cholecystectomy is less intense than after open cholecystectomy, some patients still experience considerable discomfort during the first 24 to 72 postoperative hours. The aim of this study is to evaluate the effect of intraperitoneal and port site instillation of local anaesthetics on pain relief in early postoperative period following laparoscopic cholecystectomy. Fifty patients undergoing elective laparoscopic cholecystectomy were consecutively included in this study and sample was divided into two groups. Following removal of gallbladder, Group A received 20 ml of 0.25% bupivacaine instilled in the right sub diaphragmatic space and 20 ml of 0.25% bupivacaine in divided doses at the trocar sites. The evaluation of postoperative pain was done at fixed time interval according to the numerical verbal scale and the dosage of narcotic analgesics consumed was also recorded. Mean pain scores at 6 hours and at 12 hours after surgery were 6.02 and 4.72 respectively, in the bupivacaine group compared with 8.44 and 6.08 respectively in the control group (p= <0.001 and <0.001). However, pain scores at 24 hours and 48 hours postoperatively and incidence of shoulder tip pain did not differ significantly between the two groups. The mean total narcotic analgesics used in study group was 1.91 as compared to 2.50 in the control group respectively and was found to be statistically significant (p= <0.001). Infiltration of bupivacaine in to port site and intraperitoneal space is simple, inexpensive and effective technique to minimize early postoperative pain and can be practiced for elective laparoscopic cholecystectomy.   DOI: 10.3329/medtoday.v22i1.5601 Medicine Today Vol.22(1) 2010. 24-28

scholarly journals Comparative evaluation of subcutaneous infiltration (port site) vs intraperitoneal infiltration of bupivacaine on post laparoscopic cholecystectomy pain

2018 ◽  
Vol 5 (2) ◽  
pp. 500 ◽  
Author(s):  
R. S. Gupta ◽  
A. Rai ◽  
Vikram Vasuniya ◽  
Devendra Choudhary
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Pain ◽  
Hospital Stay ◽  
Open Cholecystectomy ◽  
Port Site ◽  
Control Group ◽  
Narcotic Analgesics ◽  
Rescue Analgesia ◽  
Vas Score ◽  
Group 3

Background: Laparoscopic cholecystectomy (LC) is now the gold standard technique for the treatment of gallstones disease. Although pain after LC is less intense than after open cholecystectomy, some patients still experience considerable discomfort during early postoperative hours. The aim of this study is to evaluate the effect of intraperitoneal and port site instillation of local anaesthetics on pain relief in early postoperative period following LC.Methods: This is a randomized, prospective analytical study among patients subjected to elective laparoscopic cholecystectomy. Patients were divided into 3 groups as; Group 1 was control, Group 2 was assigned to receive portside infiltration of bupivacaine, while group 3 received combined port site and intraperitoneal instillation of bupivacaine. The evaluation of postoperative pain was done according to the visual analog scale and the dosage of narcotic analgesics consumed and duration of hospital stay was also recorded.Results: At 1st post-operative hour, minimum VAS score was in group 3 (p=0.003). At 4th post-operative hour, Minimum VAS score was in group 3(p=0.015). At 8th post-operative hour, Minimum VAS score was in group 3, (p=0.044). Patients in group 3 received a lower total amount of rescue analgesia and they also had the shortest hospital stay after LC, compared to the patients in the other groups. As regarding the incidence of right shoulder pain, group 3 has minimal no of patients experienced rt shoulder tip pain.Conclusions: Infiltration of bupivacaine into port site and intraperitoneal space is simple, inexpensive and effective technique to minimize early postoperative pain and can be practiced for elective LC.

scholarly journals Port Site Infiltration and Intraperitoneal Instillation of Bupivacaine for Post Operative Analgesia in Laparoscopic Cholecystectomy

2020 ◽  
Vol 14 (2) ◽  
pp. 58-61 ◽  
Author(s):  
Lipika Sanjowal ◽  
Swapan Kumar Biswas
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Pain ◽  
Study Groups ◽  
Treatment Method ◽  
Port Site ◽  
Control Group ◽  
Vas Score ◽  
Intraperitoneal Instillation ◽  
Elective Laparoscopic Cholecystectomy ◽  
Experimental Group

Laparoscopic cholecystectomy has become the gold standard treatment method for symptomatic gallstone diseases. However pain is the only complaint that delays the discharge. This study aimed to evaluate the efficacy of bupivacaine infiltration into port site and instillation into peritoneal cavity to reduce pain following laparoscopic cholecystectomy. One hundred patients underwent elective laparoscopic cholecystectomy enrolled in this study. Patients were divided into experimental group (Group A) and control group (Group B) of 50 patients each. Following removal of gallbladder, patients of experimental group received 20 ml of 0.5% bupivacaine in gallbladder bed and 20 ml of 0.5% bupivacaine was infiltrated into 4 port sites. Control group received no treatment. The evaluation of postoperative pain was done at 4, 8, 12 and 24 hours postoperatively by using Visual Analogue Scale and the dose of NSAID was also recorded. Mean VAS score at 4, 8 and 12 hours postoperatively in experimental group was less than that of the control group (p<0.05). VAS score at 24 hours postoperatively did not differ between two study groups (p>0.05). The mean total NSAID doses used during first 24 hours postoperatively was less in the experimental group than control group (p<0.05). The localization of pain during first 24 hours postoperatively was 62% incisional, 29% intra abdominal and shoulder tip pain 9%. Port site infiltration and intraperitoneal instillation of bupivacaine following laparoscopic cholecystectomy reduce pain following laparoscopic cholecystectomy and this simple, inexpensive and effective method should be practiced to minimize early postoperative pain for all elective laparoscopic cholecystectomy. Faridpur Med. Coll. J. Jul 2019;14(2): 58-61

scholarly journals Glisson’s capsule cauterisation is associated with increased postoperative pain after laparoscopic cholecystectomy: a prospective case–control study

2017 ◽  
Vol 99 (6) ◽  
pp. 485-489 ◽  
Author(s):  
F Basak ◽  
M Hasbahceci ◽  
A Sisik ◽  
A Acar ◽  
Y Ozel ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Pain ◽  
Case Control Study ◽  
Gallbladder Disease ◽  
Case Control ◽  
Control Group ◽  
Study Group ◽  
Pain Scores ◽  
Standard Laparoscopic Cholecystectomy ◽  
Control Study

INTRODUCTION Postoperative pain after laparoscopic cholecystectomy has three components: parietal, visceral and referred pain felt at the shoulder. Visceral peritoneal injury on the liver (Glisson’s capsule) during cauterisation sometimes occurs as an unavoidable complication of the operation. Its effect on postoperative pain has not been quantified. In this study, we aimed to evaluate the association between Glisson’s capsule injury and postoperative pain following laparoscopic cholecystectomy. METHODS The study was a prospective case–control of planned standard laparoscopic cholecystectomy with standardized anaesthesia protocol in patients with benign gallbladder disease. Visual analogue scale (VAS) abdominal pain scores were noted at 2 and 24 hours after the operation. One surgical team performed the operations. Operative videos were recorded and examined later by another team to detect presence of Glisson’s capsule cauterisation. Eighty-one patients were enrolled into the study. After examination of the operative videos, 46 patients with visceral peritoneal injury were included in the study group, and the remaining 35 formed the control group. RESULTS VAS pain score at postoperative 2 and 24 hours was significantly higher in the study group than control (P = 0.027 and 0.017, respectively). CONCLUSIONS Glisson’s capsule cauterisation in laparoscopic cholecystectomy is associated with increased postoperative pain. Additional efforts are recommended to prevent unintentional cauterisation.

Assessment of Effect of Port Site and Intraperitoneal Instillation of Bupivacaine in Reduction of Post-Operative Pain After Laparoscopic Cholecystectomy

2020 ◽  
Author(s):  
Nippun Roy
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Pain Assessment ◽  
Pain Control ◽  
Port Site ◽  
Controlled Study ◽  
Control Group ◽  
Local Infiltration ◽  
Pain Scores ◽  
Post Operative Pain ◽  
Intraperitoneal Instillation

Aim: Effective postoperative pain control is an essential component for care of surgical patients. Inadequate pain control may result in increased morbidity or mortality. Analgesic effects of periportal infiltration of local anesthetics, infiltration of periportal parietal peritoneum, intraperitoneal spraying at subdiaphragmatic space and subhepatic space covering the area of hepatoduodenal ligament have been reported. The present controlled study aimed at assessing the effect of port site injection and intraperitoneal instillation of bupivacaine in reduction of post-operative pain after laparoscopic cholecystectomy. Methods: The present study was conducted among a group of 180 patients diagnosed to have symptomatic cholelithiasis and who underwent elective laparoscopic cholecystectomy under general anesthesia. In group 1, pre-incisional local infiltration of 20ml 0.5% bupivacaine at the port sites; and in group 2, local infiltration of 20ml 0.5% bupivacaine at the port sites with intraperitonial installation. In group 3, no local infiltration was done and treated as control group. Pain assessment is based on a Universal Pain Assessment Tool. Analysis of our study was performed one-way ANOVA & Post HOC test (Scheffe's HSD) & Chi square tests as and when indicated. Results: Mean pain scores at 30 minutes were significantly lower in groups 1 & 2 compared to control group; but however, the values were not significantly different when compared to each other. Similarly, the mean pain scores at 4th, 8th, 16th and 24th hours for the preincisional and preclosure groups, didn't signify any inter-group advantage. Therefore, bupivacaine provides a substantial reduction of pain intensity up to 24 hours postoperatively; and was found to be statistically significant. However, timing of anesthesia was found to be statistically insignificant in terms of preclosure vs pre incisional of the port sites. Conclusion: Instillation of bupivacaine at the port sites in laparoscopic cholecystectomy irrespective of the timing of instillation is an effective method of achieving pain control in the post-operative period as long as 24 hours after surgery. There was no statistically significant reduction of post-operative pain between the pre-incisional and pre-closure groups.

scholarly journals Why are we still using antibiotic prophylaxis in elective laparoscopic cholecystectomy for the low-risk groups? a review of literature

2021 ◽  
Vol 8 (2) ◽  
pp. 760
Author(s):  
Devajit Chowlek Shyam ◽  
Ranjit Chowlek Shyam ◽  
Donkupar Khongwar ◽  
Dathiadiam Tongper
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Surgical Site Infection ◽  
Antibiotic Prophylaxis ◽  
Open Cholecystectomy ◽  
Gallstone Disease ◽  
Port Site ◽  
Low Risk ◽  
Site Infection ◽  
Skin Preparation ◽  
Elective Laparoscopic Cholecystectomy

Gallstone disease is one of the most common gastrointestinal conditions requiring surgery and more than 90% of cholecystectomies are done laparoscopically. The major complications of laparoscopic cholecystectomy are major bleeding, Bile duct injury, and wound infection or surgical site infection. The incidence of Surgical site infection in laparoscopic cholecystectomy (0.4-1.13%) is significantly low compared to open cholecystectomy (3-47%) and the probable reasons are the smaller incision and the use of trocar along with almost nil to minimal wound contamination as compared to open cholecystectomy. Port site infection is a type of surgical site infection (1.8%) and the Umbilical port site is the most common site followed by the epigastric port site. In spite of the low-risk of surgical site infection, many surgeons still practice antibiotic prophylaxis in elective laparoscopic cholecystectomy for low-risk patients. Antibiotic prophylaxis is a debatable topic in the low-risk group undergoing elective laparoscopic cholecystectomy.Meticulous preoperative skin preparation is one of the established local factors to prevent the occurrence of SSI.

scholarly journals Influence of Preemptive Intravenous Ibuprofen on Post-Operative Pain and Opioid Consumption after Laparoscopic Cholecystectomy

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
R A Hamad ◽  
M K Shams ◽  
M M Kamal ◽  
D M Hissein
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Pain ◽  
Postoperative Period ◽  
Open Cholecystectomy ◽  
Developed Countries ◽  
Opioid Consumption ◽  
Opioid Use ◽  
Pain Scores ◽  
A Prospective Study ◽  
Analgesic Use

Abstract Background cholecystectomy is the most common abdominal surgical procedure in developed countries, and is generally performed laparoscopically. Laparoscopic cholecystectomy is regarded as the gold standard surgical technique for gallstone diseases. This procedure results in less postoperative pain, a better cosmetic outcome, shorter hospitalization faster healing, and earlier mobilization than open cholecystectomy. Aim of the Work the purpose of this study is to investigate the effects of a single preemptive dose of IV ibuprofen on postoperative pain and opioid consumption in patients undergoing laparoscopic cholecystectomy. Patients and Methods this study will be a prospective study on patients who are scheduled for laparoscopic cholecystectomy will be informed about the different components of postoperative pain they would experience, and they will be selected by the same investigator for their ability to differentiate these pain components and to use the visual analog scale. After approval of the local ethics committee. Results this study showed that a single preemptive dose of IV ibuprofen reduced 24-hour opioid consumption and was effective in the emergence of lower pain scores in the postoperative period. In addition, IV ibuprofen significantly reduced rescue analgesic use. In addition IV ibuprofen has played a key role with opioid sparing effect. Conclusion a single preemptive dose of 400 mg resulted in better pain scores by reducing postoperative opioid use in the 1st 24 hours in patients undergoing laparoscopic cholecystectomy by 45%. It also reduced rescue analgesic use in the postoperative period and opioid-related side-effects such as nausea-vomiting.

Post-Laparoscopic Cholecystectomy Pain: Effects of Intraperitoneal Local Anesthetics on Pain Control–A Randomized Prospective Double-Blinded Placebo-Controlled Trial

2008 ◽  
Vol 74 (3) ◽  
pp. 201-209 ◽  
Author(s):  
Bestoun H. Ahmed ◽  
Aryan Ahmed ◽  
Dongfeng Tan ◽  
Ziad T. Awad ◽  
Ali Yousef Al-Aali ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Laparoscopic Cholecystectomy ◽  
Controlled Trial ◽  
Open Cholecystectomy ◽  
Isotonic Saline ◽  
Control Group ◽  
Placebo Control ◽  
Saline Irrigation ◽  
Pain Scores ◽  
Significant Difference

Postoperative pain after laparoscopic cholecystectomy (LC) is generally less than open cholecystectomy; however, the postoperative shoulder and abdominal pain experienced by patients still causes preventable distress. Intraperitoneal irrigation of the diaphragmatic surface and gallbladder fossa using normal saline, bupivacaine, or lignocaine may effectively control visceral abdominal pain after an LC. Two hundred patients with similar demographics undergoing elective LC were randomized to one of four groups of 50 patients each, including Group A placebo control, Group B with isotonic saline irrigation, Group C with bupivacaine irrigation, and Group D with lignocaine irrigation. All patients received preperitoneal abdominal wall infiltration with 0.25 per cent bupivacaine to control parietal (somatic) abdominal pain. The visual analogue and verbal rating pain scores at 0, 4, 8, 12 and 24 hours for both shoulder and abdominal pain were recorded in a prospective double-blind fashion at four points during the first 24 postoperative hours. Analgesia requirements, vital signs, blood glucose, and incidence of nausea and vomiting were also recorded. Patients in each group demonstrated a significant difference in visual analogue and verbal rating pain scores and analgesic consumption when compared with controls. Lignocaine controlled pain significantly better than saline or bupivacaine. Bowel function recovery was similar in all patients, and there were no significant complications. We conclude that intraperitoneal irrigation with either saline, bupivacaine, or lignocaine can significantly reduce visceral abdominal pain after LC. Lignocaine was the most efficacious local anesthetic in this trial and has a high safety profile when used at recommended doses.

scholarly journals The Effect of Pneumoperitoneum-induced Hypertension During Laparoscopic Cholecystectomy Under General Anesthesia on Postoperative Pain: A Randomized Clinical Trial

2022 ◽  
Vol 11 (6) ◽  
Author(s):  
Alireza Pournajafian ◽  
Ali Khatibi ◽  
Behrooz Zaman ◽  
Amir Pourabbasi
Keyword(s):  
Blood Pressure ◽  
Clinical Trial ◽  
Laparoscopic Cholecystectomy ◽  
Postoperative Pain ◽  
General Anesthesia ◽  
Randomized Clinical Trial ◽  
Pain Scores ◽  
Group A ◽  
Elective Laparoscopic Cholecystectomy ◽  
Group B

Background: Acute postoperative pain is a significant cause of morbidities. This study aimed to evaluate the effect of intraoperative blood pressure during laparoscopic cholecystectomy under general anesthesia on postoperative pain in patients without underlying disorders. Methods: In this randomized clinical trial, 72 patients undergoing general anesthesia for elective laparoscopic cholecystectomy were randomly assigned into two groups: Group A with higher than baseline preoperative blood pressure (MAP allowed to increase up to 20% higher than baseline MAP by inducing pneumoperitoneum) and group B with normal to low blood pressure (MAP deliberately controlled at a tight limit from normal baseline MAP values to 20% less than baseline by titrating TNG infusion). The Visual Analog Scale (VAS) after 2, 8, 12, and 24 hours of surgery, and the total dose of meperidine used to manage postoperative pain were recorded and compared between the two groups. Results: The pain scores in group A were significantly lower than group B (P = 0.001). The postoperative analgesia request time was different between the two groups (P = 0.53). During the first 24 hours, the total meperidine consumption dose in group A was significantly lower than in group B (P = 0.001). Conclusions: High intraoperative blood pressure may affect the postoperative pain after laparoscopic cholecystectomy and lead to less postoperative pain score and analgesic requirements.

scholarly journals Comparison of intraincisional vs intraperitoneal bupivacaine for the control of postoperative pain after laparoscopic cholecystectomy

2019 ◽  
Vol 6 (5) ◽  
pp. 1509
Author(s):  
Umar Qadir Bacha ◽  
Majid Mushtaque ◽  
Sifna Tahir
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Pain ◽  
Port Site ◽  
Controlled Study ◽  
Control Group ◽  
Randomized Controlled ◽  
Intraperitoneal Bupivacaine ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

 Background: The aim of this study was to compare the efficacy of infiltration of local anaesthetic bupivacaine at incision site (port site) and intraperitoneally on postoper­ative pain in patients undergoing laparoscopic cholecystectomy.Methods: This was a randomized controlled study carried out on patients undergoing laparoscopic cholecystectomy. The patients were divided into three groups of 60 patients each. Group 1 was the control group which did not receive either intraincisional or intraperitoneal bupivacaine. Group 2 received intraincisional bupivacaine 0.25% 20 ml, while group 3 received 20 ml solution of bupivacaine 0.25% 20 ml intraperitoneally. Postoperative pain was recorded for 24 hours post-operatively.Results: The incidence of abdominal pain was significantly lower in the group which received intraincisional bupivacaine upto 12 hours postoperatively. Right shoulder pain was low in group receiving intraperitoneal bupivacaine as compared to group 2, but it was not statistically significant.Conclusions: Intraincisional (port site) infiltration of bupivacaine is more effective than intraperitoneal infiltration for postoperative pain relief after laparoscopic cholecystectomy. It is easier to apply and there is less requirement of postoperative analgesics.

scholarly journals Transversus abdominis Plane Block for Improved Early Postoperative Pain Management after Periacetabular Osteotomy: A Randomized Clinical Trial

2021 ◽  
Vol 10 (3) ◽  
pp. 394
Author(s):  
Jannis Löchel ◽  
Viktor Janz ◽  
Vincent Justus Leopold ◽  
Michael Krämer ◽  
Georgi I. Wassilew
Keyword(s):  
Postoperative Pain ◽  
Periacetabular Osteotomy ◽  
Opioid Consumption ◽  
Transversus Abdominis ◽  
Control Group ◽  
Block Group ◽  
Tap Block ◽  
Transversus Abdominis Plane ◽  
Ultrasound Guided ◽  
Pain Scores

Background: Patients undergoing periacetabular osteotomy (PAO) may experience significant postoperative pain due to the extensive approach and multiple osteotomies. The aim of this study was to assess the efficacy of the transversus abdominis plane (TAP) block on reducing opioid consumption and improving clinical outcome in PAO patients. Patients and Methods: We conducted a two-group randomized-controlled trial in 42 consecutive patients undergoing a PAO for symptomatic developmental dysplasia of the hip (DDH). The study group received an ultrasound-guided TAP block with 20 mL of 0.75% ropivacaine prior to surgery. The control group did not receive a TAP block. All patients received a multimodal analgesia with nonsteroidal anti-inflammatory drugs (NSAID) (etoricoxib and metamizole) and an intravenous patient-controlled analgesia (PCA) with piritramide (1.5 mg bolus, 10 min lockout-time). The primary endpoint was opioid consumption within 48 h after surgery. Secondary endpoints were pain scores, assessment of postoperative nausea and vomiting (PONV), measurement of the quality of recovery using patient-reported outcome measure and length of hospital stay. Forty-one patients (n = 21 TAP block group, n = 20 control group) completed the study, per protocol. One patient was lost to follow-up. Thirty-three were women (88.5%) and eight men (19.5%). The mean age at the time of surgery was 28 years (18–43, SD ± 7.4). All TAP blocks were performed by an experienced senior anaesthesiologist and all operations were performed by a single, high volume surgeon. Results: The opioid consumption in the TAP block group was significantly lower compared to the control group at 6 (3 mg ± 2.8 vs. 10.8 mg ± 5.6, p < 0.0001), 24 (18.4 ± 16.2 vs. 30.8 ± 16.4, p = 0.01) and 48 h (29.1 mg ± 30.7 vs. 54.7 ± 29.6, p = 0.04) after surgery. Pain scores were significantly reduced in the TAP block group at 24 h after surgery. There were no other differences in secondary outcome parameters. No perioperative complication occurred in either group. Conclusion: Ultrasound-guided TAP block significantly reduces the perioperative opioid consumption in patients undergoing PAO.

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