The Effect of Subcutaneous and Intraperitoneal Instillation of Local Anesthetics on Postoperative Pain after Laparoscopic Varicocelectomy: A Randomized Controlled Trial

Background: The main goal of the present randomized clinical trial was to investigate the effects of subcutaneous administration of two different local anesthetics at trocar incision sites at the abdominal wall in combination with intraoperative intraperitoneal instillation of local anesthetics, on the character of postoperative pain, in adolescents who underwent laparoscopic varicocelectomy. Methods: A total of 60 patients with a median age of 16 years, who received laparoscopic varicocele repair, were included in this randomized clinical trial. The patients were randomly assigned to three study groups receiving 2% lidocaine, 0.5% levobupivacaine, or the control group. The Visual Analogue Scale (VAS) was used by a blinded nurse at four different time points (2, 6, 12 and 24 h after the surgery) to measure pain intensity. Results: The significant effect of time on the pain intensity (p = 0.001) was found. Additionally, the interaction between time and different local analgesics (p < 0.001) was observed. In patients in whom 0.5% levobupivacaine has been used, significantly lower VAS pain scores were recorded at each time point assessed, in comparison with the patients who received 2% lidocaine or the patients from the control group in whom no local anesthetic was applied (p < 0.001). Furthermore, in patients in whom 2% lidocaine was administrated, significantly lower pain levels according to VAS were reported than in those from the control group, except for the time point at 24 h after surgery when pain levels were comparable. Concerning the postoperative pain control, the number of patients who requested oral analgesics postoperatively was significantly lower in the group of patients in whom local anesthetic was administrated intraoperatively (2% lidocaine – n = 4, 20%; 0.5% levobupivacaine – n = 1, 5%) compared to the patients who did not receive any local anesthetic during the surgery (n = 13; 65%) (p < 0.001). Conclusion: A significant reduction in postoperative pain intensity and analgesics consumption in patients undergoing laparoscopic varicocelectomy who received intraoperative local anesthetic was observed. The best effect on postoperative pain intensity, according to the VAS score, was achieved by 0.5% levobupivacaine.

Effect of intraperitoneal instillation of dexmedetomidine or fentanyl as adjuvants to bupivacaine on fast tracking discharge criteria in patients undergoing ambulatory laparoscopic cholecystectomy: a randomised double-blind control trial

Background Postoperative analgesia in laparoscopic cholecystectomy significantly affects the ambulation and discharge of the patient. This study compares fentanyl and dexmedetomidine as adjuvants to bupivacaine in intraperitoneal instillation after LC, in terms of their impact on ambulation, analgesic efficacy and recovery profile. Ninety patients were randomised into three groups with thirty patients in each group; group BF was administered 20 ml of 2 μg/kg fentanyl + 0.25% bupivacaine, group BD received 20 ml of 1μg/kg dexmedetomidine + 0.25% bupivacaine and group B received 20 ml of 0.25% bupivacaine only. After 8 h, Post-Anaesthesia Discharge Scoring System (PADS) scored for determining home readiness. Analgesic profile was assessed using Verbal Rating Scale and rescue analgesia requirement seen. Sedation was scored using Ramsay sedation scoring. Results Group B had significantly higher VRS and rescue analgesia requirements whilst groups BF and BD had a similar analgesic profile. Ramsay sedation scores were significantly higher in group BD when compared to groups BF and B. However, the PADS score remained comparable in all three groups (P = 0.113). The trial was retrospectively registered with the clinical trial registry of India CTRI/2019/07/020466. Conclusion Intraperitoneal instillation of bupivacaine in combination with dexmedetomidine or fentanyl significantly reduces postoperative pain scores in comparison to bupivacaine alone, in patients undergoing ambulatory laparoscopic cholecystectomy. However, fentanyl may be preferred over dexmedetomidine, because it causes less sedation and achieves a better PADS score.

SP1.2.9To Evaluate the Analgesic Efficacy of Intraperitoneal Tramadol Vs Placebo for Post Operative Pain Relief Following Laparoscopic Cholecystectomy, A Double Blind Randomized Control Trial

Aim To study the effectiveness of intraperitoneal instillation of tramadol for postoperative laparoscopic cholecystectomy (LC) pain relief and improve incidence of adverse effect. Methods Double blinded randomized controlled trial over 1 year. The Ethical Clearance was obtained from Institutional Ethics Committee. 60 patients scheduled for LC were enrolled in the study. Patients were randomly assigned into 2 groups using computer generated random numbers. Group T: Received intraperitoneal tramadol 100 mg (diluted in 20 mls distilled water). Group S: Received 20 ml of intraperitoneal normal saline. Pain was assessed using VAS. The assessment was done at 0, 15, 30, 60 minutes, 4, 8, 12, 16 and 24 hours. Incidence of adverse effect were observed. Results In group T, the mean pain scores at all the intervals were significantly low (p &lt; 0.050) except at 24 hours (p = 0.210). Analgesia requirement was significantly high in group S compared to group T immediate post op, 15, 60 minutes, 8 and 12 hours (p &lt; 0.050). The mean requirement of analgesia immediate post op, 15 minutes, 4 and 8 hours was significantly low in group T compared to group S (p &lt; 0.050). 30% patients in group T did not require analgesia at all compared to S (p &lt; 0.001). Incidence of adverse effects at 4 hours was 43% in group S compared to 40% in group T (p &gt; 0.050). Conclusion Intraperitoneal instillation of tramadol in LC has beneficial effect in terms of postoperative pain relief following LC and lower requirement of analgesia. However, the incidence of adverse effects was comparable in both the groups.

A COMPARISON BETWEEN INSTILLATION OF INTRAPERITIONEAL BUPIVACAINE & MORPHINE vs. BUPIVACAINE ALONE IN ANALGESIA AFTER LAPAROSCOPIC CHOLECYSTECTOMY

Background Pain after laparoscopic cholecystectomy remains a challenging issue to this relatively less invasive surgery, In this study we try to tackle this problem through intraperitoneal injection of drugs particularly morphine and bupivicaine to reduce post-operative pain. Objectives The Aim of this study is to assess postoperative pain in laparoscopic cholecystectomy by comparing between administering intraperitoneal bupivacaine alone versus intraperitoneal bupivacaine with intravenous morphine; Using the VAS scale and measuring time for rescue analgesic administration. Methods and material This prospective double blinded randomized clinical trial study was conducted in Ain Shams University hospital after approval of the anesthesia department and the local ethics and research committee over 6 months and after obtaining a written informed consent. Sixty patients underwent laparoscopic cholecystectomy were included in the study their ages range between 18 and 60 years old and classified as ASA I and II. The patients were randomly divided using computer generated randomization into two groups 30 patients in each (n = 30), Group BM received 30 ml of mixture of bupivacaine and 2 mg morphine while group BO received bupivacaine only Results This study showed that Morphine bupivacaine admixture had made dramatic decline in shoulder and abdominal pain VAS scores specifically at the 18th and24th hour; 15 patients in the BM group had either VAS score zero or 1 when compared to BO group whom their scores at the 18th and 24th hour was between 4 and 8. Also, there was more decrease in postoperative analgesic consumption in BM group. Conclusions We conclude that intraperitoneal instillation of 2 mg to bupivacaine 0.5% in elective LC significantly reduced post-operative shoulder pain and analgesic requirement when compared to bupivacaine 0.5% alone.

COMPARING THE POST-OPERATIVE ANALGESIA USING ROPIVACAINE IN LAPAROSCOPIC CHOLECYSTECTOMY BY THREE DIFFERENT METHODS-A COMPARATIVE STUDY

Introduction: Laparoscopic cholecystectomy is a minimally invasive surgical procedure for cholecystectomy. In present time local anesthesia is widely used as analgesic by various routes including port site intraincisional inlteration, transverse abdominis plane (TAP) block and intraperitoneal instillation. Aim: Comparing The Post-Operative Analgesia Using Ropivacaine in Laparoscopic Cholecystectomy by three Different Methods ; Intraperitoneal instillation, USG-guided subcostal transversus abdominis plane block and Incisional inltration at port site. Materials and methods: This study was conducted among elective general surgical patient undergoing laparoscopic cholecystectomy in S.N. Medical College, Agra and completed in the study period of 18 months. Study population was elective surgical patients posted for elective laparoscopic cholecystectomy. Patients were divided in to 3 groups: Group A- Intraperitoneal instillation, Groups B- ultrasound guided subcostal transversus abdominis plane block and Groups C- intraincisional inlteration at port site. Results: Intraincisional inltration of ropivacaine provide signicant Postoperative pain relief in comparative to USG -guided subcostal TAP block and intraperitoneal instillation with ropivacaine. Conclusion: Intraincisional inltration of ropivacaine provide signicant Postoperative pain relief and decrease post operative analgesia requirement in comparative to USG -guided subcostal TAP block and intraperitoneal instillation with ropivacaine. Shoulder tip pain incidence, postoperative nausea and vomiting incidence lower in intraincisional inltration of ropivacaine.

COMPARATIVE STUDY OF POST OPERATIVE PAIN RELIEF IN LAPAROSCOPIC CHOLECYSTECTOMY WITH PORT SITE AND INTRAPERITONEAL INSTILLATION OF 0.5% BUPIVACAINE WITH ADRENALINE AND PLACEBO

Introduction : Postoperative pain is variable in intensity,character,duration and is the main factor delaying discharge of patients undergoing day-care procedures including laparoscopy and hence adding to hospital cost and stay. Optimal management has a potential for shortening of hospital stay and for speeding up of recovery.AIM :Comparing the effect of port site and intraperitoneal instillation of 0.5% bupivacaine with adrenaline versus saline for post-operative analgesia in laparoscopic cholecystectomy. To assess the need of rescue analgesics in post- operative period in both groups.Material & Method :A comparative study to be performed on 50 cases receive 40 mls of 0.5% bupivacaine as intraperitoneal infiltration and local infiltration of 20 mls of 0.5% bupivacaine in the port sites (5 ml infiltration in each port) versus 50 cases receive 40 ml of normal saline intraperitoneally Discussion :Reduction in post-operative pain with better cosmesis and early return to work have been the goals to improve cost effectiveness and patient satisfaction. Conclusion : We conclude that instillation of local anaesthetic drug intraperitonialy & Port site local anaesthetic agent injection has added benefits in post operative pain

EFFICACY OF INTRAPERITONEAL INSTILLATION OF 0.2% ROPIVACAINE FOR POSTOPERATIVE PAIN RELIEF AFTER LAPAROSCOPIC CHOLECYSTECTOMY

INTRODUCTION: Postoperative pain management is one of most important components of adequate postoperative patient care. Poorly treated pain contributes to patient suffering and may prevent rapid recovery and rehabilitation. Laparoscopic operative procedures have revolutionized surgery with many advantages : a smaller and more cosmetic incision, reduced blood loss, reduced postoperative hospital stay and pain, which cut 1 down hospital costs . AIMS AND OBJECTIVES:Aim of the study is to evaluate the efcacy of intraperitoneal instillation of ropivacaine for postoperative pain relief after laparoscopic cholecystectomy surgeries in terms of : Duration of analgesia, 24 hour postoperative analgesic requirement, Postoperative pain assessment, Postoperative hemodynamic changes like pulse rate, blood pressure and Complications (if any). MATERIALS AND METHODS: Study area -Command Hospital (Eastern Command), Alipore, Kolkata (operation theatre and ward). Study population - Patients posted for Elective Laparoscopic Cholecystectomy. Study period -Jan 2017 to June 2018 Study Time– From rst intraoperative intraperitoneal instillation of study drug to next 24 postoperative hours. Sample Size - 80 (40 in each group) RESULTS AND ANALYSIS: In our study, intraperitoneal instillation of Ropivacaine at the end of surgery provided analgesia for 5.54 ± 4.61 hrs. When compared with the saline group, it was about 2.22 ± 2.93 hrs, which was found to be statistically signicant (-0.004). In this study, Injection Tramadol was used for rescue analgesia for postoperative pain relief. SUMMARYAND CONCLUSION: This study has a few limitations. First, eighty study population may be underpowered for the study. Second, the surgeon performing the surgeries is not the same in every case which may alter the postoperative consequences. From this study it may be concluded that intraperitoneal instillation of Ropivacaine is effective for postoperative pain relief after laparoscopic cholecystectomy. From this study we also conclude that, intraperitoneal instillation of Ropivacaine is useful for postoperative pain relief for patients undergoing laparoscopic cholecystectomy in terms of duration of analgesia, rescue analgesic requirement and pain perception.