title: Efficacy of intraperitoneal local anaesthetic techniques during laparoscopic cholecystectomy.
abstract: BACKGROUND
  Pain following laparoscopic cholecystectomy (LC) is a barrier to early discharge. Some studies have demonstrated that local anaesthetic (LA) washed over the liver and gallbladder decreases postoperative pain. In many patients pain is partially of diaphragmatic origin which may not be treated effectively by topical wash. This study assesses the efficacy of LA injected to the peritoneum of the right hemidiaphragm or topical wash with a control group.
  
  
  METHODS
  We performed a double-blind randomized sham controlled trial of 128 consecutive subjects who underwent elective LC. Patients received subcutaneous bupivacaine, a diaphragmatic injection of bupivacaine or sham, and topical wash over the liver/gallbladder with bupivacaine or sham depending upon allocation. The primary outcome was VAS pain scores on the ward. Secondary outcomes included VRS pain scores in theatre recovery, analgesic use, physiological observations, time to eating and ambulation, and successful day-case surgery.
  
  
  RESULTS
  Pain scores were significantly lower in both LA groups versus control in theatre recovery but only in the subperitoneal diaphragm injection group when the patients returned to the ward. Subperitoneal diaphragm injection was associated with a reduced time in theatre recovery (p = 0.04).
  
  
  CONCLUSIONS
  Intraperitoneal techniques of LA during LC decrease postoperative pain and shorten time in theatre recovery. Injection of LA to the right hemidiaphragm is associated with lower pain scores for a longer period following LC than a previously validated wash technique.
authors.affiliation: Department of Hepatopancreatobiliary Surgery, University Hospitals Coventry and Warwickshire, c/o Mr. Lam's secretary, Walsgrave Hospital, Clifford Bridge Road, Coventry CV2 2DX, UK. j.k.roberts@bham.ac.uk
authors.forename: K J
authors.initials: KJ
authors.lastname: Roberts
authors.forename: J
authors.initials: J
authors.lastname: Gilmour
authors.forename: R
authors.initials: R
authors.lastname: Pande
authors.forename: P
authors.initials: P
authors.lastname: Nightingale
authors.forename: L C
authors.initials: LC
authors.lastname: Tan
authors.forename: S
authors.initials: S
authors.lastname: Khan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use; D000772:Anesthesia, Local; 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; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D000700:Analgesics; D000779:Anesthetics, Local; D002045:Bupivacaine