Effectiveness of pre-incisional port sites infiltration of bupivacaine in reducing early postoperative pain after laparoscopic cholecystectomy
Keywords:Pre-incisional, port-site, local anesthetic (Bupivacaine), postoperative pain, Laparoscopic Cholecystectomy.
Objective: To observe the effectiveness of pre-incisional port site instillation of local anesthetic Bupivacaine in reducing early postoperative pain after laparoscopic cholecystectomy.
Methodology: A Prospective Randomized controlled trial was performed at the Department of surgery, KRL Hospital, Islamabad from April to October 2016. Sixty patients in total undergoing laparoscopic cholecystectomy admitted through OPD/emergency department were included in the study by consecutive non probability sampling technique. Patients were randomized into intervention Group A and Control Group B. In Group A pre-incisional port sites were instilled with Bupivacaine, while in Group B no Bupivacaine was instilled at the port site. In both groups, all patients received Bupivacaine instillation intraperitoneal to mask the effect of visceral pain component from postoperative port site somatic pain.
Results: Out of total of 60 patients, in Group A the mean age was 36.27 + 12.21 & in Group B was 35.57 + 11.12. Female: male ratio in group A was 5:1 and 4:1in group B. The ASA status for patients in Group A: 93.4% in ASA I, while 6.7% in ASA II. In Group B, patients with ASA I were 86.7% and 13.4% in ASA II. The mean VAS at “12” hours postoperatively for Group A was 3.70 + 2.20 & 5.13 + 2.22 for Group B with P value of 0.0150 which is statistically significant. So, statistically postoperative pain on VAS in Group A was lower than in Group B up to 12 hours post operatively. Concluding, a significant statistical difference was found for early postoperative pain between the two groups.
Conclusion: Pre-incisional, port-site infiltration of Bupivacaine reduces the frequency and intensity of postoperative pain in the early postoperative period of Laparoscopic Cholecystectomy. Thereby, reducing analgesic requirements and early discharge.
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