title: Preinsertion local anesthesia at the trocar site improves perioperative pain and decreases costs of laparoscopic cholecystectomy.
abstract: BACKGROUND
  Local anesthesia at the trocar site in laparoscopic cholecystectomy is expected to decrease postoperative pain and hence expedite recovery. The aims of this prospective randomized study were to investigate the effect of local anesthesia and to discover whether it is cost effective.
  
  
  METHODS
  For this study, 100 patients undergoing laparoscopic cholecystectomy were randomized into two groups. The 43 study patients were injected with 0.5% bupivacaine hydrochloride at the trocar site before the trocars were inserted. They then were compared with 41 control patients who received no local anesthesia. The remaining 16 patients were excluded from the study. The postoperative pain was evaluated at the standard four trocar sites at 4 h and 24 h after surgery on a scale 1 (the mildest pain the patient had ever experienced) to 10 (the most severe pain the patient had ever experienced). Postoperative pain medications and their cost were evaluated.
  
  
  RESULTS
  There was no difference between the two groups with regard to gender, age, weight, operative time, estimated operative blood loss, and bile culture. The patients who received bupivacaine at the trocar site clinically had less pain (p < 0.001 for all four sites) both at 4 and 24 h after surgery. The treatment group patients used less mepiridine and promethzine than the control group (p = 0.001 and 0.002, respectively) postoperatively. Overall, the patients who had local anesthesia used less postoperative pain and antiemetic medication than the control patients (p = 0.02). This afforded a significant decrease in the costs and charges of these medications (p = 0.004 and 0.005, respectively). Three patients in the study group were discharged from the hospital the day of surgery.
  
  
  CONCLUSIONS
  Preinsertion of local anesthesia at the trocar site in laparoscopic cholecystectomy significantly reduces postoperative pain and decreases medication usage costs.
authors.affiliation: Department of Surgery, Lee County Community Hospital, Medical Arts Building Suite #2, West Alternative Highway 58, Pennington Gap, VA 24277, USA.nahidh@pol.net
authors.forename: N W
authors.initials: NW
authors.lastname: Hasaniya
authors.forename: F F
authors.initials: FF
authors.lastname: Zayed
authors.forename: H
authors.initials: H
authors.lastname: Faiz
authors.forename: R
authors.initials: R
authors.lastname: Severino
mesh_terms: D000009:Abdominal Muscles / Q000601:surgery; D000772:Anesthesia, Local / Q000379:methods*; D002045:Bupivacaine / Q000008:administration & dosage / Q000627:therapeutic use; D017081:Cholecystectomy, Laparoscopic / Q000191:economics* / Q000379:methods*; D002769:Cholelithiasis / Q000191:economics / Q000601:surgery*; D003363:Cost Control; D017048:Health Care Costs; D006801:Humans; D008614:Meperidine / Q000008:administration & dosage / Q000627:therapeutic use; D010146:Pain / Q000517:prevention & control*; D010149:Postoperative Pain / Q000517:prevention & control; D019990:Perioperative Care; D011398:Promethazine / Q000008:administration & dosage / Q000627:therapeutic use; D013525:Surgical Instruments; D016896:Treatment Outcome
chemical_list: D008614:Meperidine; D011398:Promethazine; D002045:Bupivacaine