THE EFFECT OF TOPICAL INTRAPERITONEAL BUPIVACAINE ON POSTOPERATIVE PAIN FOLLOWING LAPAROSCOPIC CHOLECYSTECTOMY

Laparoscopic cholecystectomy is associated with less patient discomfort, shorter hospital stays and more rapid return to work than open cholecystectomy. Nevertheless, it is not a pain free procedure. Peritoneal irritation at the time of surgery can cause significant pain. Topical instillation of local anaesthetics reduces post-operative pain following diagnostic laparoscopy and laparoscopic tubal ligations. A similar benefit has not been demonstrated in upper abdominal laparoscopic procedures. This study was designed to assess the effect on post-operative pain of 30 cc of 0.5% bupivacaine with 1:200 000 epinephrine administered at the completion of laparoscopic cholecystectomy. Laparoscopic cholecystectomy was performed on 46 patients, 23 of whom received bupivacaine and 23 received saline. Post-operative pain was assessed by reviewing nursing records and by analysis of analgesic requirements of each patient. In patients receiving bupivacaine, analgesic requirement was significantly lower at 4-8 h and 24 h post-operatively. The fraction of patients receiving bupivacaine who subjectively reported pain to nurses (10/23) was significantly less than in the control group (18/23). Patients receiving bupivacaine also had a significantly shorter hospital stay than patients in the control group (1.3 days versus 1.9 days). We conclude that topical administration of bupivacaine at the completion of laparoscopic cholecystectomy diminishes post-operative pain and decreases hospital stay. Long-acting local anaesthetics provide significantly increased post-operative pain control when administered at the completion of laparoscopic procedures.