Effect of Bupivacaine on Postoperative Pain after Laparoscopic Cholecystectomy

To determine whether intraoperative local injection of 0.5% bupivacaine around port sites would decrease early postoperative pain after laparoscopic cholecystectomy, and the use of intravenous opioid analgesics postoperatively.

Randomised controlled trial.

Department of Surgery, Khyber Teaching Hospital, Peshawar, from July 2016 to June 2017.

Patients who underwent laparoscopic cholecystectomy were divided into two groups. Group A had instillation of 20 ml of 0.5% Inj. bupivacaine at the end of procedure into port sites and group B had no bupivacaine injection at trocar sites. Both groups had postoperative intravenous ketorolac 30 mg three times daily and intravenous opioid analgesics on demand. Pain was assessed 2 hours after recovery from general anesthesia, and at 6, 12 and 24 hours through visual analog scale 0-10.

One hundred and twenty patients completed this study with 60 patients in each group. A significant difference in mean postoperative pain scores was observed at 2 and 6 hours after surgery between the groups. Pain scores at 2 and 6 hours after surgery were 3.97 +1.327 and 3.02 ±1.08 in group A, while it was 4.65 +1.448 and 4.72 ±1.277 in group B with p-values of 0.008 and 0.005, respectively. There was no significant difference in mean postoperative pain scores at 12 and 24 hours between the groups, with pain scores of 3.72 ±0.78 and 3.75 ±0.95 (p=0.488 and 0.744, respectively). However, there was a significant difference in opioid analgesics use in first 24 hours with less analgesics use in bupivacaine injected group.

Injecting 0.5% bupivacaine at trocar sites during laparoscopic cholecystectomy offers significant reduction in early postoperative pain.