Placement of 0.5% bupivacaine-soaked Surgicel in the gallbladder bed is effective for pain after laparoscopic cholecystectomy.
BACKGROUND
This study aimed to determine the character of pain after laparoscopic cholecystectomy and its relief with 0.5% bupivacaine-soaked Surgicel placed in the gallbladder bed.


METHODS
For this study, 60 patients with chronic cholecystitis were divided into four groups of 15 each: group A (bupivacaine-soaked Surgicel kept in gallbladder bed), group B (bupivacaine infiltrated at trocar sites), group C (bupivacaine infiltrated into the gallbladder bed and at trocar sites, and group D (normal saline in the gallbladder bed and at trocar sites). Postoperatively, the character of pain was noted, and its relief was assessed with visual analog scale (VAS) scoring.


RESULTS
The findings showed that 78.33% of the patients had visceral pain, 70% experienced parietal, and 23.33% reported shoulder pain after laparoscopic cholecystectomy. The visceral pain was significantly less in the group A patients than in the control subjects (p < 0.05), and none of them experienced shoulder pain. The mean VAS score at 4, 8, and, 24 h in the group A patients also was less than in control group D: 26.37 +/- 16.24 versus 38.30 +/- 9.51, 23.23 +/- 14.28 versus 33.73 +/- 7.96, and 18.36 +/- 13.00 versus 28.60 +/- 9.42, respectively. Trocar-site infiltration alone was not effective in relieving the parietal pain.


CONCLUSIONS
Visceral pain is prominent after laparoscopic cholecystectomy and can be effectively controlled by 0.5% bupivacaine-soaked Surgicel in the gallbladder bed alone. Trocar-site infiltration alone is ineffective.
Verma
G R
GR
Department of Surgery and Anesthesia, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Lyngdoh
T S
TS
Kaman
L
L
Bala
I
I
D000328:Adult; D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage*; D002483:Cellulose, Oxidized; D017081:Cholecystectomy, Laparoscopic; D002764:Cholecystitis / Q000601:surgery; D002908:Chronic Disease; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*
D000779:Anesthetics, Local; D002483:Cellulose, Oxidized; C013695:Surgicel; D002045:Bupivacaine