Evaluation of Intraperitoneal installation of Bupivacaine for post operative analgesia in patients undergoing laparoscopic Cholecystectomy: A randomized control trial

Background: Laparoscopic Cholecystectomy being promoted as a Day care surgery now a day, therefore, adequate pain relief in post operative period is a must for patient’s compliance. Incorporation of intraperitoneal installation of Bupivacaine as a part of multimodal analgesic regime provides significant post operative analgesia. This study evaluates the role of intraperitoneal spraying of bupivacine in patients undergoing laparoscopic cholecystectomy for adequate post operative analgesia. Methods and Materials: Sixty ASA I, II patients with uncomplicated cholelithiasis, undergoing laparoscopic cholecystectomy were randomly divided in two groups. Group 1 was the study group where 20 ml of 0.5% bupivacaine was instilled and group 2 was the control group where 20 ml of normal saline was instilled into the gall bladder fossa and sub-diaphragmatic space at the end of the surgery. The VAS, total requirement of rescue analgesia and time to the first dose of rescue analgesia was noted at regular intervals over the 24 hour postoperative period. Results: In the study group, 50% (i.e. 15 out of 30) of the patients required only a single dose of rescue analgesia over the 24 hour observation period. Another 40% (i.e. 12 out of30) required two doses and the remaining 10% (i.e. 3 out of 30) required three doses of rescue analgesia. In the control group 56.7 % (i.e. 17 out of 30) of the patients required three doses of rescue analgesia, another 30% (i.e. 9 out of 30) required two doses while the remaining 13.3% (i.e. 4 out of 30) patients required four doses of rescue analgesia over the period of observation. These results are highly significant. Conclusion: Intraperitoneal instillation of bupivacaine in the gall bladder fossa and sub diaphragmatic surface is safe and has an effect in alleviating postoperative pain thereby minimizing the requirements of analgesics and it can be incorporated as a routine practice and as a part of multimodal analgesic regime.