Intraperitoneal Hydrocortisone plus Bupivacaine administration For Pain Relief after Laparoscopic Cholecystectomy, A Comparison with Bupivacaine Alone

 Introduction: shorter hospital stay and less pain in comparison to open surgery considered to be major benefits for laparoscopic cholecystectomy. We compared the effect of intraperitoneal hydrocortisone plus bupivacaine with bupivacaine alone on pain relief following laparoscopic cholecystectomy.  Methods: Sixty two patients participated in this double-blind, randomized clinical trial. Patients randomly received intraperitoneal instillation of either 100 mg bupivacaine in 250 ml normal saline (n=32) or 100 mg hydrocortisone plus 100 mg bupivacaine in 250 ml normal saline (n=30) before insufflation of CO2 into the peritoneum. Abdominal and shoulder pain were evaluated using VAS postoperatively. The patients were also followed for postoperative analgesic requirements, nausea and vomiting, and return of bowel function.  We used independent Student t-test and Chi-square test and Mann-Whitney U tests with SPSS software to compare quantitative and qualitative variables, respectively. P value less than 0.05 was considered significant.   Results: Sixty patients completed the study. Patients in the hydrocortisone plus bupivacaine group had significantly lower abdominal and shoulder pain scores (11.72 vs 8.92 in the bupivacaine and bupivacaine plus hydrocortisone group, respectively P<0.01). The patients were similar regarding analgesic requirements .The patients were similar with respect to return of bowel function, nausea and vomiting. No adverse reaction was observed in either group.  Conclusions: Intraperitoneal administrations of hydrocortisone plus bupivacaine can alleviate pain after laparoscopic cholecystectomy better than intraperitoneal bupivacaine alone.