The combination of infiltrative bupivacaine with low-pressure laparoscopy reduces postcholecystectomy pain.  A prospective randomized controlled study.
OBJECTIVE
To evaluate the efficacy of combined  infiltrative bupivacaine with low intraperitoneal pressure insufflation in reducing the post-laparoscopic pain in patients undergoing laparoscopic cholecystectomy (LC).


METHODS
This randomized prospective single-blind study included 473 patients undergoing LC. The study took place at University Hospital Center Mother Teresa, Tirana, Albania between  January 2006 to September 2009. The patients were divided in 4 groups: Group 1 (n=120) with intra-abdominal insufflation pressure 15 mm Hg and no infiltrative bupivacaine (HPNBG); Group 2 (n=122) with intra-abdominal insufflation pressure 15 mm Hg and with 5 ml infiltrative bupivacaine 0.5% in abdominal minincisions (HPBG); Group 3 (n=110) with intra-abdominal insufflation pressure under 10 mm Hg and no infiltrative bupivacaine (LPNBG); and Group 4 (n=121) with intra-abdominal insufflation pressure under 10 mm Hg and infiltrative bupivacaine (LPBG).


RESULTS
There were statistically significant differences (p=0.003) between groups regarding incisional pain intensity, between LPBG and HPNBG (p=0.001), between LPBG and HPBG (p=0.037), between LPBG and LPNBG (p=0.001), as well the shoulder-tip pain intensity (p=0.001); between LPBG and HPNBG (p=0.001), between LPBG and HPBG (p=0.001), and between LPBG and LPNBG (p=0.031). We found statistically significant differences related to pain beginning time (ANOVA test, p=0.027); between LPBG and HPNBG (p=0.041), between LPBG and HPBG (p=0.031), and between LPBG and LPNBG (p=0.05).


CONCLUSIONS
The combination of infiltrative bupivacaine with low intraperitoneal pressure insufflation shows to be more efficient in reducing the post-laparoscopic pain, compared with other regimens.
Department of General Surgery, University Hospital Center Mother Teresa, Tirana, Albania.
Arben I
AI
Beqiri
Rudin Q
RQ
Domi
Hektor H
HH
Sula
Edmond Q
EQ
Zaimi
Elizana Y
EY
Petrela
D000328:Adult; D000779:Anesthetics, Local / Q000627:therapeutic use*; D002045:Bupivacaine / Q000627:therapeutic use*; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D005260:Female; D006801:Humans; D007327:Insufflation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000517:prevention & control*; D011312:Pressure; D011446:Prospective Studies; D020069:Shoulder Pain / Q000517:prevention & control; D016037:Single-Blind Method
D000779:Anesthetics, Local; D002045:Bupivacaine