Assessment of Pain Outcome and Amount of Analgesic Required Post Operatively After Instillation of Bupivacaine amongst Pre Incisional Vs. Postincisional Vs. Control Groups

Instillation of Bupivacaine amongst Pre Incisional Vs. Postincisional Vs. Control Groups

Abstract

Background: Effective postoperative pain control is an essential component for care of surgical patients. Although opioid analgesics are effective in treating postoperative pain, concerns regarding their ability to increase nausea, vomiting and to produce respiratory depression have limited their use during laparoscopic procedures.  The study aimed to provide impetus for further research and help in performance of laparoscopic cholecystectomy as a day care procedure.Subjects and Methods:The present study was conducted on a group of 180 patients diagnosed to have symptomatic cholelithiasis and who underwent elective laparoscopic cholecystectomy.  In one group, pre-incisional local infiltration of 20ml 0.5% bupivacaine at the port sites  with intraperitonial installation of 10ml 0.25% bupivacaine was done throughout all the layers of the abdominal wall (till peritoneum).  In group 2, local infiltration of 20ml 0.5% bupivacaine at the port sites with intraperitonial installation of 10ml 0.25% bupivacaine was done after the completion of surgical procedure, and just before the closure of skin.   The analysis was done using one way ANOVA & Post HOC test (Scheffes HSD) & Chi square tests. Parameters studied are side effects like nausea/ vomiting and the additional need of rescue analgesia along with elapsed time for 1st rescue analgesia.Results:Our patients in both the study groups received the first analgesic drug much later (~6 hours postoperatively) as compared to the control group (2.3 hours post operatively). The total analgesic requirement post operatively was also lower in the study group with respect to the control group. (150 mg vs 300 mg of injDiclofenac sodium) There was no significant difference in the incidence of shoulder tip pain amongst the three groups. 11 out of 180 patients in the study group experienced post-operative nausea while 6 out of 60 patients in the control group experienced nausea.Conclusion: To conclude, technique of instillation of bupivacaine at the port sites in laparoscopic cholecystectomy is simple, safe and without adverse effects. It is likely to be cost effective, because it decreases post-operative usage of NSAIDS or opioids, and helps in better resource utilization for treatment of postoperative pain and also useful for patient to provide a more comprehensive and comfortable post-operative period.