Impact of low-pressure pneumoperitoneum and local anesthetic combination on postoperative pain in patients undergoing laparoscopic cholecystectomy

Objective. Despite the advantages of laparoscopic cholecystectomy (LC), postoperative pain remains a major complaint for many patients. In this study, in patients undergoing LC, the application of LC via incisional bupivacaine and low inflation pressure, alone or combined, and a comparison of the effects on postoperative pain has been purposed. Methods. Patients were randomly assigned into the following 4 groups: the standard pressure (SP) group (n = 30); patients with an intraabdominal insufflation pressure of 12 mmHg, where bupivacaine application was not performed at the trocar locations. The SP+local anesthetic (LA) (SP+LA) group (n = 30); patients with an intraabdominal insufflation pressure of 12 mmHg, where bupivacaine application was performed at the trocar locations. The low pressure (LP) group (n = 30); patients with an intraabdominal insufflation pressure of 8 mmHg, where bupivacaine application was not performed at the trocar locations. The (LP+LA) group (n = 30); patients with an intraabdominal insufflation pressure of 8 mmHg, where bupivacaine application was performed at the trocar locations. Postoperative pain was evaluated using the visual analogous scale (VAS). Results. When the relationships between the VAS scores, gender, age, and American Society of Anesthesiologists classification were evaluated, no significant relationships between the groups were observed (p > 0.05). A significant relationship between the groups was detected with regards to the VAS scores, 1st analgesic application, 2nd analgesic application, and patients’ satisfaction (p < 0.05). Conclusions. The combination of low insufflation pressure with intrafacial preincisional local anesthetic infiltration in post-LC pain palliation is thought to be more effective and applicable.