Efficacy of High-Volume Low-Concentration Intraperitoneal Bupivacaine Irrigation for Postoperative Analgesia in Patients Undergoing Laparoscopic Cholecystectomy: Bupivacaine Irrigation for Analgesia.

Abstract

Background: Intraperitoneal irrigation with a low-volume, high-concentration local anaesthetic in laparoscopic cholecystectomy (LC) provides less pain relief. We investigated the impact of high-volume, low-concentration bupivacaine on postoperative pain and opioid requirement. Methods: Patients undergoing LC were randomised into Group B (20 mL of 0.5% bupivacaine in 480 mL normal saline) or Group S (500 mL of normal saline). Fifteen patients were included in both the groups but one patient was excluded from Group S because of bile duct injury. The primary outcome was Duration of Analgesia (DOA). The secondary outcomes were the Numeric Pain Rating Scale (NRS) at extubation, at 15 min, 30 min and 1, 2, 4, 8, 12 and 24 h. Cumulative rescue analgesics, incidence of postoperative nausea, vomiting and shoulder pain. Results: Mean (median/range) duration of analgesia was 6.45 ± 5.57 h (6/0.15-24) in Group B vs 3.18 ± 4.21 h (0.3/0.15-12) in Group S. Cumulative requirement of rescue analgesic was higher in saline group being 56.25 ± 33.92 mg for diclofenac and 83.57 ± 66.75 mg for tramadol vis-à-vis 40.9 ± 39.17 mg and 30.00 ± 52.78 mg, respectively, in bupivacaine group. Conclusion: Irrigation of the peritoneal cavity with high-volume low-concentration bupivacaine in LC increases the duration of analgesia and decreases the analgesic requirement in the postoperative period. Trial Registration: ClinicalTrials.gov identifier: CTRI/2019/02/017802 dated 25/02/2019.