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Postoperative Pain Reduction with Bupivacaine Instillation After Laparoscopic Cholecystectomy

Authors: Sami Hasson --- Firas AL Chalabi
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2013 Volume: 12 Issue: 2 Pages: 186-191
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

BACKGROUND:Pain occurs frequently following laparoscopic cholecystectomy leading to increased patientsdistress, delayed discharge, increase the need for analgesia and delayed oral intake. OBJECTIVE: To evaluate the effect of bupivacaine instillation on pain relief in the early post- operative periodfollowing laparoscopic cholecystectomy. MATERIALS AND METHODS: Eighty patients having symptomatic gall stones were included in this study. The procedure wasexplained to the patients and informed consent was obtained. The patients were divided into twogroups: group (A) received 40 ml of(0.125%) bupivacaine diluted in 60 ml of isotonic saline(0.9%)instilled in the subdiaphragmatic and subhepatic spaces, the remaining 40ml of (0.125%)bupivacaine were used for wounds infiltration. The post operative pain was assessed by visualanalogue scale(VAS) at fixed time intervals, both patients and house officer doctor were blinded tothe group of the patients. Group (B) stood as a control group.RESULTS: The two groups were comparable in age, gender, weight, and duration of operation. The maleto female ratio was (1:4), the mean age in both groups were insignificantly different, theirweights ranged from (58- 96) kg. Post operative abdominal pain was significantly lower in group A(bupivacaine group) than group B ( control group) in the first twelve hours.The mean abdominal pain score ranged from (3.85 to 2.55) for the bupivacaine group, and from(6.62 to 3.16) in the control group, the p value is < 0.001which is highly significant in the first 6hours. Group A had a lower incidence of shoulder pain in comparison with the control groupalthough statistically not significant. CONCLUSION: Intraincisional infiltration with bupivacaine is a simple and feasible procedure which significantly reduces post operative pain

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