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Abstract

BACKGROUND: Pain occurs frequently following laparoscopic cholecystectomy leading to increased patients distress, 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 period following laparoscopic cholecystectomy. MATERIALS AND METHODS: Eighty patients having symptomatic gall stones were included in this study. The procedure was explained to the patients and informed consent was obtained. The patients were divided into two groups: 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 visual analogue scale(VAS) at fixed time intervals, both patients and house officer doctor were blinded to the 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 male to female ratio was (1:4), the mean age in both groups were insignificantly different, their weights 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 6 hours. Group A had a lower incidence of shoulder pain in comparison with the control group although statistically not significant. CONCLUSION: Intraincisional infiltration with bupivacaine is a simple and feasible procedure which significantly reduces post operative pain

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