title: Bupivacaine instillation into gallbladder bed after laparoscopic cholecystectomy: does it decrease shoulder pain?
abstract: BACKGROUND
  Shoulder pain is common after laparoscopic cholecystectomy (60.5%) and can delay return to normal activities. The cause is unclear but may involve referral of pain from the traumatized area.
  
  
  METHODS
  A total of 75 patients with chronic cholecystitis who underwent laparoscopic cholecystectomy were randomized into two groups. Group I (37 patients) had 10 mL of 0.25 % bupivacaine instilled into the gallbladder bed and Calot's triangle area at the end of cholecystectomy. Group II (38 patients) served as controls and had no bupivacaine instillation. Postoperative shoulder pain was evaluated.
  
  
  RESULTS
  Six patients in Group I developed shoulder pain (16%) compared with 23 patients in Group II (60.5%). The difference was statistically significant (P = 0.0002).
  
  
  CONCLUSIONS
  The raw area of the removed organ is at least partially responsible for shoulder pain after laparoscopic cholecystectomy. Local bupivacaine is effective in reducing such pain.
authors.affiliation: Department of General Surgery, Princess Basma Teaching Hospital, Faculty of Medicine, University of Science & Technology, Irbid, Jordan. kiag@go.com.jo
authors.forename: K I
authors.initials: KI
authors.lastname: Gharaibeh
authors.forename: T M
authors.initials: TM
authors.lastname: Al-Jaberi
mesh_terms: D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage; D002045:Bupivacaine / Q000008:administration & dosage / Q000627:therapeutic use*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D002764:Cholecystitis / Q000601:surgery; D002908:Chronic Disease; D006801:Humans; D007322:Instillation, Drug; D010149:Postoperative Pain / Q000517:prevention & control*; D020069:Shoulder Pain / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000779:Anesthetics, Local; D002045:Bupivacaine