Randomized, controlled trial of bupivacaine injection to decrease pain after laparoscopic cholecystectomy.
ABSTRACT To determine if intraoperative instillation of bupivacaine would decrease early postoperative pain after laparoscopic cholecystectomy, if the patients would consequently require less narcotic postoperatively and if such patients would elect to be discharged on the day of operation if given the choice.
Double-blind, randomized, controlled trial.
A tertiary care hospital in Hamilton, Ont.
Fifty patients underwent laparoscopic cholecystectomy. Day-surgery patients had the choice of staying overnight for discharge the following day. They were compared with a control group of 47 patients who had laparoscopic cholecystectomy but did not receive bupivacaine.
Instillation of 20 mL of 0.5% bupivacaine with epinephrine into laparoscopic cholecystectomy port sites intraoperatively before closure.
Visual analogue scale (VAS) pain scores assessed 4 times postoperatively, the choice of patients to leave hospital the same day or to remain in the hospital overnight; the level of postoperative narcotic usage.
Mean VAS pain scores (range 0 [no pain] to 5 [severe pain]) at less than 2 hours and at 6 hours after surgery were 2.9 and 2.9, respectively, in the bupivacaine group compared with 4.5 and 4.0, respectively, in the control group (p = 0.001 and 0.025). VAS scores at 10 hours postoperatively and the next morning did not differ between the groups. More patients in the bupivacaine group elected to go home on the day of surgery (p = 0.034). Narcotic usage was not significantly different.
Instillation of bupivacaine into port sites should be standard practice for elective laparoscopic cholecystectomy.
SourceAvailable from: Ibrahim A Abdelazim[Show abstract] [Hide abstract]
ABSTRACT: To detect the effect of intra-peritoneal instillation of local anesthetic with or without NSAIDs on pain relief after gynecological laparoscopy.07/2012; 2(2). DOI:10.1016/S2305-0500(13)60136-0
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ABSTRACT: Pain relief after laparoscopic cholecystectomy (LC) is an issue of great practical importance. Pain after LC has several origins: incisional, local visceral, peritoneal, and referred. Several modalities have been employed for achieving effective and safe analgesia: nonsteroidal anti-inflammatory drugs (NSAIDs) and cyclooxygenase-2 (COX-2) inhibitors, gabapentinoids, local anesthetics, and transversus abdominis plane (TAP) block. They have their advantages and disadvantages, and multimodal approaches are often followed because of the multiple sources of pain. Among COX-2 inhibitors, parecoxib and valdecoxib are useful, and fears regarding their cardiovascular adverse effects in noncardiac surgery (such as LC) have not been substantiated when used in short term. Gabapentin is useful but more data are needed regarding pregabalin because of inconsistent results. Local anesthetics (LA) can be particularly useful, both port-site infiltration and intraperitoneal instillation in the intra-operative period. Factors enhancing the effectiveness of these agents include early instillation before creating the pneumoperitoneum, larger volume of medium used for instillation, and favorable pharmacological characteristics of the agent. Combination of LA with either NSAID/COX-2 inhibitors or fibrin sealant appears to be effective, although more research is required for determining the exact combinations and efficacy using direct comparisons with single-modality interventions. Finally, newer procedures such as TAP block appear promising if replicated.Pain Practice 10/2011; 12(6):485-96. DOI:10.1111/j.1533-2500.2011.00513.x · 2.18 Impact Factor
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ABSTRACT: The aim of this clinical trial was to determine the potential analgesic effect of preoperative paravertebral blockade in patients undergoing laparoscopic cholecystectomy. Sixty patients scheduled for laparoscopic cholecystectomy were randomized to one of two groups with 30 patients each: bilateral nerve stimulator guided paravertebral blockade at the T5 to T6 level either prior to induction of general anesthesia (Group 1) or blockade immediately postoperatively (Group 2). The preoperative paravertebral block group had significantly lower visual analog scale scores compared with the postoperative paravertebral block group both at rest 12 hours postoperatively (1.06 vs. 1.89; P < 0.05), on movement 12 hours postoperatively (1.89 vs. 3.00; P < 0.001) and on coughing 12 hours postoperatively (2.24 vs. 3.17; P < 0.01). The consumption of analgesics as well as the duration of hospital stay was significantly reduced in patients receiving preoperative paravertebral blocks (P < 0.05). [Correction added after online publication 27th May 2011: visual analog scores were amended] Bilateral paravertebral blockade performed prior to general anesthesia for laparoscopic cholecystectomy can provide early discharge and better postoperative pain management.Pain Practice 03/2011; 11(6):509-15. DOI:10.1111/j.1533-2500.2011.00447.x · 2.18 Impact Factor