Effect of Bupivacaine with and without Intra Peritoneal Instillation on Postoperative Visceral Pain after Laparoscopic Cholecystectomy

Background: Laparoscopic Cholecystectomy is the treatment of choice for symptomatic gallstones disease. Open cholecystectomy results mainly in parietal pain while laparoscopic cholecystectomy causes visceral pain. Objective: To compare post-operative visceral pain at 24 hours in patients undergoing laparoscopic cholecystectomy with and without intra peritoneal instillation of bupivacaine. Methodology: Setting: Surgical Unit II, Sheikh Zayed Medical College/Hospital Rahim st st Yar Khan. Duration of Study: 1 July to 31 December 2015. Study design: Randomized controlled trial (RCT). A total of 60 patients having symptomatic gallstones disease were included in this study. Patients were randomly divided into two groups. Thirty patients in group A were treated with bupivacaine 0.5 % instillation. For the patients in group B, the dose was not instilled in the gall bladder fossa and right and left sub diaphragmatic spaces. Postoperative pain was assessed up to 24hours after surgery using Visual Analogue Scale (VAS). The data was entered and analyzed by using SPSS version 16. Results: The mean age of the patients was 35±8 years in group A, and 37± 8 years in Group B. Post operative pain at 24 hours was significantly low in group A than in group B (33.3% vs. 70%; p=0.004). Conclusion: Intraperitoneal bupivacaine instillation after laparoscopic cholecystectomy reduces pain in the initial postoperative period. It is easy to administer with no adverse effects and may become a routine practice for this procedure.