title: Randomized trial of periportal peritoneal bupivacaine for pain relief after laparoscopic cholecystectomy.
abstract: The aim of this study was to determine whether injection of a long-acting local anaesthetic, in relation to the port sites at the level of the parietal peritoneum, would reduce postoperative pain following laparoscopic cholecystectomy. Patients were entered into a randomized, prospective, double-blind study comparing the effects of a standard technique, in which bupivacaine (total of 20 ml, 0.5 per cent) was injected into the subcutaneous periportal tissue around the four port sites, and a technique in which bupivacaine (total of 20 ml, 0.25 per cent) was injected into the subcutaneous periportal tissue as above with the addition of periportal parietal peritoneal injection of bupivacaine (total of 20 ml, 0.25 per cent). Two scores for pain, with the patient at rest, and on movement, were assessed 6 and 18 h after surgery using a visual analogue pain scale. Median pain score was significantly higher in patients who received standard technique (n = 40) than in those given peritoneal injection (n = 40) at both 6 (rest = 3.0 versus 1.0, movement = 5.0 versus 2.9) and 18 h (rest = 1.9 versus 0, movement = 3.2 versus 1.2). Both opiate and oral analgesic requirements were reduced in patients administered peritoneal injection, although this was not statistically significant. The addition of periportal injection of bupivacaine at the level of the parietal peritoneum, performed under direct vision, reduces pain after laparoscopic cholecystectomy.
authors.affiliation: Department of Surgery, National University Hospital, Singapore.
authors.forename: D J
authors.initials: DJ
authors.lastname: Alexander
authors.forename: S S
authors.initials: SS
authors.lastname: Ngoi
authors.forename: L
authors.initials: L
authors.lastname: Lee
authors.forename: J
authors.initials: J
authors.lastname: So
authors.forename: K
authors.initials: K
authors.lastname: Mak
authors.forename: S
authors.initials: S
authors.lastname: Chan
authors.forename: P M
authors.initials: PM
authors.lastname: Goh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000517:prevention & control*; D011446:Prospective Studies
chemical_list: D000779:Anesthetics, Local; D002045:Bupivacaine