Randomised Controlled Clinical Trial of Combined Port Site Infiltration and Intraperitoneal Irrigation with Bupivacaine on Post Operative Pain After Laparoscopic Cholecystectomy

Laparoscopic cholecystectomy is the most commonly done procedure for gallstone diseases and is characterized by a short hospital stay. However, pain is one of the most important reasons for overnight stay following laparoscopic cholecystectomy. This study aims to evaluate the effect of infiltration of bupivacaine at the laparoscopic port sites and intraperitoneal wash of gallbladder bed with bupivacaine on post operative pain after laparoscopic cholecystectomy. This study included 60 patients undergoing elective laparoscopic cholecystectomy who were prospectively randomized into 2 groups. The placebo group (n = 30) received a saline wash without bupivacaine installed into the gallbladder bed. The bupivacaine group (n = 30) received an intraperitoneal wash of the gallbladder bed with 30 cc of 0.5% bupivacaine and another 20 cc of 0.5% bupivacaine was infiltrated into the port sites. Pain was assessed at 1, 2, 6, 12 and 24 h post surgery using a visual analogue scale (VAS). Rescue analgesics used and duration of hospital stay were also recorded. The visual analogue score was significantly lower immediately after laparoscopic cholecystectomy for the bupivacaine group. Patients in the bupivacaine group also required a lower total amount of rescue analgesics during their hospital stay. They also had a shorter hospital stay after laparoscopic cholecystectomy compared to the patients in the placebo group. Combined port site infiltration and intraperitoneal irrigation of gallbladder bed with bupivacaine after laparoscopic cholecystectomy significantly decreased early post operative pain and may explain the reduced use of rescue analgesics and earlier discharge of the patients in our study.