The Effectiveness of Bupivacaine Instillation on Postoperative Pain after Elective Laparoscopic Cholecystectomy: A Prospective Randomized Controlled Trial

Abstract

Background: The gold-standard procedure for the surgical treatment of gallstone disease is Laparoscopic Cholecystectomy. With better pain management Laparoscopic Cholecystectomy can be practiced as Day-case surgery by the reduction in post-op pain, reduced analgesia demand, early mobility, and shorter hospital stay. Materials and Methods: This study was conducted at the department of general surgery, Pakistan Institute of Medical Sciences (PIMS) Complex, Islamabad from July 2016 to January 2018. A total of 164 patients were selected for the study. Patients aged 13 and above who were diagnosed with symptomatic cholelithiasis, gall bladder polyps or sludge were included in the study. Informed consent was taken. The patients were classified into two groups based on the intervention by instillation of Bupivacaine in one group and no intervention in the other. Results: Out of these 82 (50%) were installed with bupivacaine at the final stage of closure at peritrocar, sub-phrenic and gallbladder bed and in remaining 82 no instillation of any drug at aforementioned sites was done. The outcome was measured between these two groups in terms of time for first demand of analgesia, the frequency of the demand by the patient, time to mobility and post-op hospital stay. Conclusion: This study showed that there was a significant difference in the outcome of instillation of bupivacaine in subphrenic space, gall bladder bed and peritrocal site on Postoperative Pain after Elective Laparoscopic Cholecystectomy.