title: Double-blind randomized sham controlled trial of intraperitoneal bupivacaine during emergency laparoscopic cholecystectomy.
abstract: BACKGROUND
  Intraperitoneal local anesthesia (IPLA) during elective laparoscopic cholecystectomy (el-LC) decreases post-operative pain. None of the studies have explored the efficacy of IPLA at emergency laparoscopic cholecystectomy (em-LC). A longer operative duration, the greater frequency of washing, and the inflammation associated with cholecystitis or pancreatitis are a few reasons why it cannot be assumed that a benefit in pain scores will be seen in em-LC with IPLA. This study was undertaken to assess the efficacy of IPLA in patients undergoing em-LC.
  
  
  METHODS
  Double-blind randomized sham controlled trial was conducted of 41 consecutive subjects undergoing em-LC. IPLA was delivered by a combination of injection to the diaphragmatic and topical wash over the liver and gallbladder with bupivacaine or saline. The primary outcome was visual analogue scale pain scores until discharge. Secondary outcomes included pain scores in theatre recovery and analgesic consumption.
  
  
  RESULTS
  One patient had a procedure converted to open and was excluded. There was no significant difference in pain scores in the ward or theatre recovery. Analgesic use, respiratory rate, oxygen saturation, duration to ambulation, eating, satisfaction scores, and time to discharge were comparable between the two groups.
  
  
  CONCLUSIONS
  IPLA during em-LC does not influence postoperative pain. Other modalities of analgesia should be explored for decreasing the interval between diagnosis of acute admission and em-LC.
authors.affiliation: Department of Hepatopancreatobiliary Surgery, University Hospitals Coventry and Warwickshire, United Kingdom. j.k.roberts@bham.ac.uk
authors.forename: Keith J
authors.initials: KJ
authors.lastname: Roberts
authors.forename: Jeff
authors.initials: J
authors.lastname: Gilmour
authors.forename: Ruplay
authors.initials: R
authors.lastname: Pande
authors.forename: James
authors.initials: J
authors.lastname: Hodson
authors.forename: For Tai
authors.initials: FT
authors.lastname: Lam
authors.forename: Saboor
authors.initials: S
authors.lastname: Khan
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000700:Analgesics / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects; D004311:Double-Blind Method; D004630:Emergencies; D004739:England; D005260:Female; D006801:Humans; D007274:Injections, Intraperitoneal; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D010351:Patient Discharge; D007507:Therapeutic Irrigation; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000700:Analgesics; D000779:Anesthetics, Local; D002045:Bupivacaine