Intraperitoneal Pre-Insufflation of 0.125% Bupivaciane with Tramadol for Postoperative Pain Relief Following Laparoscopic Cholecystectomy
Objective: To compare the efficacy of intraperitoneal pre-insufflation of combined 0.125% bupivacaine and tramadol with bupivacaine alone in controlling postoperative pain among patients undergoing laparoscopic cholecystectomy. Study Design: Randomized Controlled Trial Place and Duration: The study was conducted at department of surgery, Holy Family, hospital, Rawalpindi from November 2016 to December 2017.
Methodology: Patients of either gender with ASA-1 and ASA-2 undergoing elective laparoscopic cholecystectomy were randomly divided into two groups of 50 each, by random number table method. The patients received the study drugs at the initiation of insufflation of CO2 in the intraperitoneal space by the operating surgeon under laparoscopic camera guidance over the gallbladder bed, tramadol 2 mg/kg in 30 ml of 0.125% bupivacaine was instilled in the gall bladder fossa under direct laparoscopic control in (study group) group A patients while group B patients received bupivacaine 30 ml of 0.125% solution only. Simultaneously, each group was assessed for intensity of pain at rest through VAS at 1, 4, 12 and 24 hrs after surgery.
Results: The mean age of group A (intervention group) was 43.25 ± 8.56 years and of group B (control group) was 44.89 ± 7.65 years. There were 24 (48%) male patients in group A and 29 (58%) in group B. In intervention group 34 (68%) patients and in control group 38 (76%) patients presented with ASA-I. The intervention group (Group A) had significantly (p-value < 0.05) lower mean values at 1 hour (3.89 ± 1.24 vs 5.79 ± 1.35), 4 hours (2.76 ± 2.13 vs 4.27 ± 1.08), 12 hours (2.28 ± 1.05 vs 4.89 ± 0.95) and 24 hours (2.16 ± 0.89 vs 3.23 ± 0.79) as compared with control group (Group B). The analysis showed that there was no statistically significant (p-value > 0.05) difference in side effects like nausea, vomiting, and shivering between both groups A and B.
Conclusion: Intraperitoneal instillation of bupivacaine plus tramadol reduces not only the intensity of postoperative pain but also the total rescue analgesic dose consumption after LC.
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