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

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.

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.

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

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.