THE EFFECT OF POST-INCISIONAL INJECTION OF BUPIVACAIN ON POST-OPERATIVE PAIN IN LAPAROSCOPIC CHOLECYSTECTOMY: A PROSPECTIVE RANDOMIZED STUDY

Abstract

A prospective, double-blind, randomized trial was done with the aim to assess whether local post-incisional injection of bupivacaine decreases pain in patients undergoing laparoscopic cholecystectomy. Forty patients operated on for symptomatic cholecystolithiasis in the Hepatoponcreatobiliary Surgery Unit of the İstanbul Faculty of Medicine were randomized to either receive post-incisional local injection of bupivacaine or serve as controls. The two groups were well-matched in terms of age, sex and duration of surgery. In the study group, a total of 10 ml bupivacaine was injected subcutaneously at the trocar incisions at the end of fhe operation. Postoperative analgesia was done in both groups with the perfusion of pethidine through the use of patient controlled analgesia (PCA). Visual analog scala (VAS) was used for the assessment of pain at 1, 6, 12 and 24 hours after the operation and was documented by an anesthesiologist blinded as to which group the patient belonged. Blood samples were taken 1 hour before and 1 hour and 24 hours after the operation for the determination of cortisole, beta-endorphinand pethidine levels. While the VAS scores were found to be lower in the study group, this reached statistical significance only at the 24th hour (p<0.05). The mean amount of pethidine used, on the other hand, was significantly lower in the study group compared to controls (p<0.05) which was reflected by the significantly lower blood levels of the drug at 24 hours. No statistically significant difference was found at the blood levels of beta-endorphin and cortisole, although both were found to be lower in the study group at each evaluation. In conclusion, local post-incisional injection of bupivacaine significantly decreases pain and the need for analgesia following laparoscopic cholecystectomy.