scholarly journals Comparison of Intraperitoneal Bupivacaine and Intravenous Ketorolac for Postoperative Pain Management Following Laparoscopic Cholecystectomy

2021 ◽  
Vol 11 (6) ◽  
Author(s):  
AmirAhmad Arabzadeh ◽  
Mirsalim Seyedsadeghi ◽  
Nahideh Sadeghi ◽  
Kazem Nejati ◽  
Ali Mohammadian Erdi
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Side Effects ◽  
Postoperative Pain ◽  
Shoulder Pain ◽  
Intravenous Injection ◽  
Intraperitoneal Injection ◽  
Nausea And Vomiting ◽  
Intraperitoneal Bupivacaine ◽  
Control Pain ◽  
Intravenous Ketorolac

Background: Postoperative pain following laparoscopic cholecystectomy (LC) arises from incision sites and residual intraperitoneal CO2 gas. Opioids as a class of pain-relieving drugs are broadly used to control pain after LC; however, these drugs can cause various side effects. Objectives: The purpose of this study was to compare the efficacy of intraperitoneal injection of bupivacaine with that of intravenous ketorolac in managing postoperative pain in patients who had undergone LC. Methods: This randomized, double-blind clinical trial was carried out on patients who had undergone LC. Ninety patients who had undergone elective LC were randomly divided into 3 groups (n = 30 for each group). Group A received 40 mL of 0.25% bupivacaine solution intraperitoneally at the end of the operation; group B received 30 mg of ketorolac intravenously 30 minutes before surgery and every 8 hours after surgery, and patients in group C received normal saline intraperitoneally and intravenous injection. The patients were postoperatively assessed for Visual Analog Scale (VAS) scores, postoperative opioid consumption, shoulder pain, side effects (sedation, nausea, and vomiting), and satisfaction. The data were analyzed using SPSS. P values < 0.05 were considered significant. Results: The intraperitoneal injection of bupivacaine and intravenous injection of ketorolac were significantly effective in reducing postoperative abdominal pain, shoulder pain, and incidence of nausea and vomiting compared to the placebo group (P < 0.001). Although intraperitoneal bupivacaine and intravenous ketorolac had no significant difference in pain relief compared with each other, patients in both bupivacaine and ketorolac groups were significantly more satisfied with their analgesia compared to the control group (P < 0.001). Conclusions: Intraperitoneal injection of bupivacaine and intravenous injection of ketorolac both are safe and effective methods to control pain, nausea, and vomiting after LC.

Intraperitoneal Versus Interpleural Morphine or Bupivacaine for Pain after Laparoscopic Cholecystectomy 

1995 ◽  
Vol 82 (3) ◽  
pp. 634-640 ◽  
Author(s):  
Hans Schulte-Steinberg ◽  
Ernst Weninger ◽  
Dominik Jokisch ◽  
Bernhard Hofstetter ◽  
Axel Misera ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Side Effects ◽  
Shoulder Pain ◽  
Opioid Receptors ◽  
Saline Group ◽  
Morphine Group ◽  
Opioid Administration ◽  
Intravenous Morphine ◽  
Intravenous Saline ◽  
Intraperitoneal Bupivacaine

Background Opioids can produce peripheral analgesic effects by activation of opioid receptors on sensory nerves. This study was designed (1) to examine a novel route of opioid administration, the intraperitoneal injection; (2) to compare this to interpleural application, and (3) to compare opioid with local anesthetic effects under both conditions. Methods At the end of laparoscopic cholecystectomy, 110 patients received the following injections in a double-blind, randomized manner: Group 1 (n = 18) was given intraperitoneal morphine (1 mg in 20 ml saline) and 20 ml intravenous saline. Group 2 (n = 17) received intraperitoneal saline and 1 mg intravenous morphine. Group 3 (n = 15) received 20 ml 0.25% intraperitoneal bupivacaine and intravenous saline. Group 4 (n = 20) received interpleural morphine (1.5 mg in 30 ml saline) and 30 ml intravenous saline. Group 5 (n = 20) received interpleural saline and 1.5 mg intravenous morphine. Group 6 (n = 20) received 30 ml 0.25% interpleural bupivacaine and intravenous saline. Postoperative pain was assessed using a visual analog scale, a numeric rating scale, and the McGill pain questionnaire. Pain localization, supplemental analgesic consumption, vital signs, and side effects were recorded for 24 h. Results Neither intraperitoneal nor interpleural morphine produced significant analgesia after laparoscopic cholecystectomy (P &gt; 0.05, Kruskal-Wallis test), whereas interpleural bupivacaine was effective (P &lt; 0.05, Kruskal-Wallis test, up to 6 h postoperatively) but not intraperitoneal bupivacaine (P &gt; 0.05, Kruskal-Wallis test). Shoulder pain was not prevalent in the majority of patients during the first 6 h. By 24 h, about half of the patients complained of shoulder pain, which was rated "low" by about one-third of all patients. No significant side effects occurred. Conclusions Interpleural bupivacaine (0.25%) produces analgesia after laparoscopic cholecystectomy. We attribute the lack of effect of intraperitoneal injections to the small dose and to a rapid dilution within the peritoneal cavity. The fact that interpleural morphine (0.005%) is ineffective may be due to an intact perineurial barrier in the noninflamed pleural cavity, which restricts the transperineurial passage of morphine to opioid receptors on intercostal nerves.

High-Volume, Low-Concentration Intraperitoneal Bupivacaine Study in Emergency Laparoscopic Cholecystectomy: A Double-Blinded, Prospective Randomized Clinical Trial

2020 ◽  
pp. 155335062091419
Author(s):  
Alpen Yahya Gumusoglu ◽  
Sina Ferahman ◽  
Mehmet Emin Gunes ◽  
Ahmet Surek ◽  
Serhan Yilmaz ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Laparoscopic Cholecystectomy ◽  
Postoperative Pain ◽  
Shoulder Pain ◽  
Test Group ◽  
High Volume ◽  
Control Group ◽  
Low Concentration ◽  
Analgesic Consumption ◽  
Intraperitoneal Bupivacaine

Background. Laparoscopic cholecystectomy (LC) often results in postoperative pain, especially in the abdomen. Intraperitoneal local anesthesia (IPLA) reduces pain after LC. Acute cholecystitis–associated inflammation, increased gallbladder wall thickness, dissection difficulties, and a longer operative time are several reasons for assuming a benefit in pain scores in urgent LC with IPLA application. The aim was to determine the postoperative analgesic efficacy of high-volume, low-dose intraperitoneal bupivacaine in urgent LC. Materials and Methods. Fifty-seven patients who were American Society of Anesthesiologists physical status I or II were randomly assigned to receive either normal saline (control group) or intraperitoneal bupivacaine (test group) at the beginning or end of urgent LC. The primary outcome was the postoperative pain score of the Visual Analogue Scale (VAS). The secondary outcomes included Visual Rating Prince Henry Scale (VRS), patient satisfaction, and analgesic consumption. Results. Postoperative VAS scores at the first and fourth hours were significantly lower in the test group than in the control group ( P < .001). Postoperative VRS scores at the first, fourth, and eighth hours were significantly lower in the test group than in the control group ( P < .001, P = .002, P = .004, respectively). Analgesic use was significantly higher in the control group at the first postoperative hour ( P < .001). Shoulder pain was significantly lower, and patient satisfaction was significantly higher in the test group relative to the control group (both P < .001). Conclusion. High-volume, low-concentration intraperitoneal bupivacaine resulted in better postoperative pain control and reduced incidence of shoulder pain and analgesic consumption in urgent LC.

Effect of gabapentin in postoperative pain, nausea, and vomiting in patients undergoing laparoscopic cholecystectomy

2015 ◽  
Vol 4 (4) ◽  
pp. 565 ◽  
Author(s):  
Janmejai Sharma ◽  
Anurag Bijalwan ◽  
Mirza Beg ◽  
Shaktibala Dutta ◽  
Shalu Bawa ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Pain ◽  
Nausea And Vomiting

scholarly journals Comparison Postoperative Shoulder Pain, Nausea, and Vomiting Between Low and Normal Pressure Pneumoperitoneum in Laparoscopic Cholecystectomy

2017 ◽  
Vol 2 (2) ◽  
Author(s):  
Behzad Nematihonar ◽  
Hosein Fahimihanzaei ◽  
Mohammadreza Kamranmanesh ◽  
Elham Memary ◽  
Arash Shahbazi ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Shoulder Pain ◽  
Normal Pressure ◽  
Nausea And Vomiting ◽  
Postoperative Shoulder

The Effect of Intraperitoneal Administration of Dexamethasone on Abdominal Pain and Shoulder Pain after Selected Cholecystectomy by Laparoscopic Method

2021 ◽  
Vol 15 (12) ◽  
pp. 3589-3592
Author(s):  
Mahdi Neshan ◽  
Saeed Kargar ◽  
Seyed Mostafa Shiryazdi ◽  
Mohammad Zare ◽  
Abdolhamid Amooei ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Laparoscopic Cholecystectomy ◽  
Shoulder Pain ◽  
Strong Association ◽  
Recovery Period ◽  
Intraperitoneal Administration ◽  
Nausea And Vomiting ◽  
Control Group ◽  
Post Operation ◽  
Random Number Table

Introduction: Laparoscopic cholecystectomy is the standard treatment of cholecystitis. In comparison to open surgery, it has advantages such as a shorter recovery period and a shorter hospital stay. One of the side effects of this treatment is abdominal and shoulder pain after surgery. The purpose of this study was to see how intraperitoneal dexamethasone affects abdominal and shoulder pain following laparoscopic cholecystectomy. Methods and materials: This study included 70 patients aged 18-70 years who were candidate for laparoscopic elective cholecystectomy. Using a random number table, patients were separated into two equal groups. In the first group, after laparoscopy and before trocar removal, 20 cc of ringer serum containing 8 mg dexamethasone was sprayed in the diaphragm and peritoneal cavity, and in the second group, 20 cc ringer was sprayed. Visual analog scale (VAS) pain score was used to assess post operation pain. Results: From 6 o'clock on, there was a substantial difference in abdominal pain between the two groups, with the control group experiencing higher pain. From 12 o'clock onwards, there was a strong association between shoulder discomfort in the two groups, and patients in the control group experienced more pain. Furthermore, the control group received more opioids. Patients in the control group experienced higher nausea and vomiting starting 12 hours after surgery. Conclusion: After laparoscopic surgery, dexamethasone can relieve abdominal and shoulder discomfort, as well as nausea and vomiting, and it can also reduce the need for opioids. Dexamethasone appears to be effective in minimizing postoperative complications. Keywords: Postoperative Pain, Intraperitoneal, Dexamethasone, Laparoscopy

scholarly journals Intraperitoneal Bupivacaine for Postoperative Pain Relief After Laparoscopic Cholecystectomy

Pain Medicine ◽  
2006 ◽  
Vol 7 (6) ◽  
pp. 539-541 ◽  
Author(s):  
Selcuk M. Hazinedaroglu ◽  
Huseyin A. Kayaoglu ◽  
Yesim Ates ◽  
Sebnem Ertürk ◽  
Canan Butuner ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Pain ◽  
Pain Relief ◽  
Postoperative Pain Relief ◽  
Intraperitoneal Bupivacaine

scholarly journals Laparoscopic cholecystectomy in hepatitis C liver cirrhosis patients: “to drain or not to drain: impact on postoperative pain”

2019 ◽  
Vol 6 (8) ◽  
pp. 2708
Author(s):  
Ahmed Mohamed Abdelaziz Hassan ◽  
Magdy M. A. Elsebae ◽  
Mohamed Abbas ◽  
Hussien Ezzat ◽  
Mohamed Z. Ali ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Laparoscopic Cholecystectomy ◽  
Hepatitis C ◽  
Postoperative Pain ◽  
Hospital Stay ◽  
Nausea And Vomiting ◽  
Analgesic Requirement ◽  
Group I ◽  
Duration Of Surgery ◽  
Drain Group

Background: When cirrhotic patients with symptomatic gallstones require laparoscopic cholecystectomy (LC), the drainage tube is supposed to prevent postoperative abdominal radiating to the right shoulder, nausea and vomiting due to pneumoperitoneum using carbon dioxide gas. Aim of this work is to evaluate the effect of placing of drains on the incidence of postoperative pain, nausea and vomiting in those patients.Methods: sixty-four patients with uncomplicated chronic calcular cholecystitis and liver cirrhosis were recruited for the study during the period from February 2017 to February 2019. They electively operated upon at the department of general surgery of Theodor Bilharz Research Institute (TBRI) using laparoscopic technique. Patients were subdivided into two equal groups Group-I (n=32); suction drains were placed in the sub-hepatic region (Morison’s pouch) and Group-II (n=32), no drains were placed. Duration of surgery, postoperative shoulder tip pain and vomiting and analgesics requirement were evaluated and recorded.Results: Operative time's difference was not statistically significant between the two groups. Drain group had a significant lower shoulder tip pain and analgesic requirement at post-operative 6 and 12 hours but that was higher After 12 hours, than group without drain. The overall incidence of nausea/vomiting was significantly higher statistically in group without drain than in drain group. Patients in drain group had a significantly longer hospital stay as compared to group without drain that was statistically significant.Conclusions: Although the incidence of pain and nausea/vomiting are less in early  post-operative period after LC  with abdominal drain in hepatitis C liver cirrhosis patients; its routine use is not justified because post-operative pain and analgesic requirement  after 12 hours is higher and hospital stay is longer. 

Sign in / Sign up

Export Citation Format

Share Document