Advance Search

The Effect of Placing 0.5% Bupivacaine-Soaked Gelfoam in the Gallbladder Bed on Pain after Laparoscopic Cholecystectomy

Saeed Dakheel Saeed
General surgeon, Shaqlawa Hospital.
Ali A. Al-Dabbagh
General surgeon, Rizgary Teaching Hospital
Keywords:
Copyright and Licensing:

Copyright (c) 2009 Saeed Dakheel Saeed, Ali A. Al-Dabbagh (Author)

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Share:
Crossref
Scopus
Google Scholar
Europe PMC

Abstract

Background and objective: Patients undergoing laparoscopic cholecystectomy (LC) experiences post operative abdominal pain. This study aimed to determine the character of pain after LC and its relief with 0.5% bupivacaine-soaked gelfoam placed in the gallbladder bed.

Methods: A prospective randomized, double blinded placebo-controlled study was conducted on 200 patients with chronic cholecystitis, patients were divided into four groups of 50 patients :group A (2 mg/kg 0.5% bupivacaine-soaked gelfoam kept in gallbladder bed), group B (2 mg/kg 0.5% bupivacaine infiltrated at trocar sites), group C ( 1/2 of the required dose of 2 mg/kg 0.5% bupivacaine infiltrated into the gallbladder bed and at trocar sites, and group D (normal saline in the gallbladder bed and at trocar sites). Postoperatively, the character of pain was noted, and its relief was assessed with verbal rating scale (VRS) scoring.

Results: 77.50% of the patients had visceral, 60.50% had parietal, and 23.50% had shoulder pain postoperatively. The visceral pain was significantly less in group A patients than in the control patients (p < 0.01),the mean VRS score at 4, 8, 12 and 24 h in the group A patients also was less than in control group D. Trocar-site infiltration alone was not effective in relieving the parietal pain.

Conclusion: Visceral pain is prominent after laparoscopic cholecystectomy and can be effectively controlled by 0.5% bupivacaine-soaked gelfoam in the gallbladder bed alone.

pdf
pdf

Metrics

Metrics Loading ...

References

  1. Hernandez j, Tortosa J, Nuno de la Rosa V, Gimenez J, Ramirez G, Robles R. Intrperitoneal application of bupivacaine plus morphine for pain relief after laparoscopic cholecystectomy.E J Anesthesia. 2003;20;891- 6.
  2. Papagiannopoulou P, Argiriadou H, Georgiou M, Papaziogas B, Sfyra E, Kanakoudis F. Preincisional local infiltration of levobupivacaine vs ropivacaine for pain control after laparoscopic cholecystectomy. Surg Endosc 2003;17: 1961–64.
  3. Boddy A, Mehta S, and Rhodes M .The Effect of Intraperitoneal Local Anesthesia in Laparoscopic cholecystecotmy: A Systematic Review and Meta-Analysis. Anesth Analg 2006;103:682–8.
  4. O’Hanlon D, Colber H, Ragheb J, McEntee J,Chambers F, Moriarty D. Intraperitoneal Pethidine versus Intramuscular Pethidine for the Relief of Pain after Laparoscopic Cholecystectomy: World J. Surg 2000;26, 1432–36.
  5. Inan A Sen M, Dener C. Local Anesthesia Use for Laparoscopic Cholecystectomy. World J Surg 2004; 28, 741– 44.
  6. Karaaslan M, Sıvacı R, Akbulut G, Dilek O. Preemptive Analgesia in Laparoscopic Cholecystectomy:A Randomized Controlled Study. Pain Practice 2006;6: 2006 237–41.
  7. Jabbour-Khoury S, Dabbous A, Gerges F, Azar M, Ayoub A, Khoury G. Intraperitoneal and Intravenous Routes for Pain Relief in Laparoscopic Cholecystectomy. JSLS 2005; 9:316– 21.
  8. Paulson J, Mellinger J Baguley W. The use of intraperitoneal bupivacaine to decrease the length of stay in elective laparoscopic cholecystectomy patients. Am Surg 2003; 69: 275–78.
  9. M. Barczyn´ ski M, Konturek A, Herman R. Superiority of preemptive analgesia with intraperitoneal instillation of bupivacaine before rather than after the creation of pneumoperitoneum for laparoscopic cholecystectomy:a randomized, double-blind, placebo-controlled study. Surg Endosc 2006; 20: 1088– 93.
  10. Jiranantarat V, Rushatamukayanunt W, Lert-akyamanee N. Analgesic effect of intraperitoneal instillation of bupivacaine for postoperative laparoscopic cholecystectomy.J Med Assoc Thai 2002;85(supplement 3): S897–S903.
  11. 11-Wills V. L, Hunt D. R. Pain after laparoscopic cholecystectomy. BJS 2000; 87, 237 –84.
  12. 12- Elhakim M, Elkott M, Ali N Tahoun F. Intraperitoneal lidocaine for postoperative pain after laparoscopy. Acta Anaesthesiol Scand 2000; 44: 280–84.
  13. Uzunkoy A, Coskun A & Akinci OF. The value of pre-emptive analgesia in the treatment of postoperative pain after laparoscopic cholecystectomy. Eur Surg Res 2001; 33: 39–41.
  14. Pourseidi B, Khorram-Manesh A., Effect of intercostals neural blockade with Marcaine (bupivacaine) on postoperative pain after laparoscopic cholecystectomy. Surg Endosc 2007;21: 1557– 59.
  15. Gupta A. Local anaesthesia for pain relief after laparoscopic cholecystectomy—a systematic review. Best Practice & Research Clinical Anaesthesiology 2005;19(2) 275–92.
  16. Bisgaard T, Klarskov B, Kristiansen VB. Multi-regional local anesthetic infiltration during laparoscopic cholecystectomy in patients receiving prophylactic multi-modal analgesia: a randomized, double-blinded, placebo-controlled study. Anesth Analg 1999; 89: 1017– 24.
  17. Lepner U, Goroshina J , Samarutel J. Postoperative pain relief after laparoscopic cholecystectomy: a randomised prospective double-blind clinical trial. Scand J Surg 2003; 92: 121– 24.
  18. Joris J, Thiry E, Paris P. Pain after laparoscopic cholecystectomy: characteristics and effect of intraperitoneal bupivacaine. Anesth Analg 1995; 81: 379– 84.
  19. Mraovic B, Jurisic T, Kogler-Majeric V. Intraperitoneal bupivacaine for analgesia after laparoscopic cholecystectomy. Acta Anaesthesiol Scand 1997; 41: 193– 96.
  20. Adams WJ, Avramovic J, Barraclough BH . Wound infiltration with 0.25% bupivacaine is not effective for postoperative analgesia after cholecystectomy. Aust N Z J Surg 1991;61: 626– 30.
  21. Gharaibeh KI , Al-Jaberi TM. Bupivacaine instillation into gallbladder bed after laparoscopic cholecystectomy: does it decrease shoulder pain? J Laparoendosc Adv Surg Tech A 2000; 10: 137– 41.
  22. Gupta A, Thorn SE, Axelsson K. Postoperative pain relief using intermittent injections of 0.5% ropivacaine through a catheter after laparoscopic cholecystectomy. Anesth Analg 2002; 95: 450– 56.
  23. Cunniffe M, McAnena O, Dar M, Calleary J,Flynn N. A Prospective Randomized Trial of Intraoperative Bupivacaine Irrigation for Management of Shoulder-tip pain following Laparoscopy. AJS 1998;176:215- 19.
  24. Elfberg B, Sjövall-Mjöberg S. Intraperitoneal bupivacaine does not effectively reduce pain after laparoscopic cholecystectomy: a randomized, placebo-controlled and double-blind study. Surg lap, End & Percutaneous Techniques 2000;10: 357– 59.
  25. Scheinin B, Kellokumpu I, Lindgren L . Effect of intraperitoneal bupivacaine on pain after laparoscopic cholecystectomy. Acta Anaesthesiol Scand 1995; 39: 195–198.
  26. Zmora O, Stolik-Dollberg O, Bar-Zakai B, Rosin D, Kuriansky J, Shabti M, et al. Intraperitoneal bupivacaine does not attenuate pain following laparoscopic cholecystectomy. JSLS 2000; 4: 301–4.
  27. Schulte-Steinberg H, Weninger E, Jokisch D. Intraperitoneal versus interpleural morphine or bupivacaine for pain after laparoscopic cholecystectomy. Anesthesiology 1995; 82: 634– 40.
  28. Kucuk C, Kadiogullari N, Canoler O, Savli S. A placebo-controlled comparison of bupivacaine and ropivacaine instillation for preventing postoperative pain after laparoscopic cholecystectomy, Surg Today 2007; 37:396–400.
  29. Weber A, Munoz J, Garteiz D et al. Use of subdiaphragmatic bupivacaine instillation to control postoperative pain after laparoscopic surgery. Surg Laparosc Endosc 1997; 7: 6–8.
  30. White P, Katzung B. Local Anesthetics, Bertram G. Katzung, editor. Basic and Clinical pharmacology, ninth edition, by the Mc Graw – Hill companies,Inc. United States of American 2004; 418 – 427.
  31. Palazon H, Tortosa J. A., De la Rosa V.N . Intraperitoneal application of bupivacaine plus morphine for pain relief after laparoscopic cholecystectomy. Eur J Anaesthesiology 2003; 20: 891– 96.
How to Cite
Saeed, S. D., & Al-Dabbagh, A. A. (2009). The Effect of Placing 0.5% Bupivacaine-Soaked Gelfoam in the Gallbladder Bed on Pain after Laparoscopic Cholecystectomy. Zanco Journal of Medical Sciences (Zanco J Med Sci), 13(1), 24–30. https://doi.org/10.15218/zjms.2009.005

Send mail to Author

Send Cancel