Randomized, controlled trial of bupivacaine injection to decrease pain after laparoscopic cholecystectomy.
OBJECTIVE
To determine if intraoperative instillation of bupivacaine would decrease early postoperative pain after laparoscopic cholecystectomy, if the patients would consequently require less narcotic postoperatively and if such patients would elect to be discharged on the day of operation if given the choice.


METHODS
Double-blind, randomized, controlled trial.


METHODS
A tertiary care hospital in Hamilton, Ont.


METHODS
Fifty patients underwent laparoscopic cholecystectomy. Day-surgery patients had the choice of staying overnight for discharge the following day. They were compared with a control group of 47 patients who had laparoscopic cholecystectomy but did not receive bupivacaine.


METHODS
Instillation of 20 mL of 0.5% bupivacaine with epinephrine into laparoscopic cholecystectomy port sites intraoperatively before closure.


METHODS
Visual analogue scale (VAS) pain scores assessed 4 times postoperatively, the choice of patients to leave hospital the same day or to remain in the hospital overnight; the level of postoperative narcotic usage.


RESULTS
Mean VAS pain scores (range 0 [no pain] to 5 [severe pain]) at less than 2 hours and at 6 hours after surgery were 2.9 and 2.9, respectively, in the bupivacaine group compared with 4.5 and 4.0, respectively, in the control group (p = 0.001 and 0.025). VAS scores at 10 hours postoperatively and the next morning did not differ between the groups. More patients in the bupivacaine group elected to go home on the day of surgery (p = 0.034). Narcotic usage was not significantly different.


CONCLUSIONS
Instillation of bupivacaine into port sites should be standard practice for elective laparoscopic cholecystectomy.
Dath
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D
Department of Surgery, St. Joseph's Hospital, McMaster University, Hamilton, Ont.
Park
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AE
D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage; D002045:Bupivacaine / Q000008:administration & dosage; D017081:Cholecystectomy, Laparoscopic; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D016896:Treatment Outcome
D000779:Anesthetics, Local; D002045:Bupivacaine