Prospective Randomized Controlled Trial Comparing Standard Analgesia with Combined Intra-operative Cystic Plate and Port-site Local Anesthesia for Post-operative Pain Management in Elective Laparoscopic Cholecystectomy

Overview

Journal Surg Endosc

Publisher Springer

Specialties Gastroenterology
General Surgery
Radiology

Date 2016 Jun 22

PMID 27324337

Citations 5

Authors

Mladjan Protic

Radovan Veljkovic

Anton J Bilchik

Ana Popovic

Milana Kresoja

Aviram Nissan

Itzhak Avital

Alexander Stojadinovic

Affiliations

Soon will be listed here.

Abstract

Background: Various mechanisms, including somatic and visceral nociceptive stimulation, have been suggested as a cause for pain after laparoscopic cholecystectomy (LC). We therefore conducted a prospective randomized controlled trial (PRCT) to evaluate whether somatovisceral pain blockade reduces pain after LC.

Hypothesis: Analgesic efficacy of multimodal analgesia is superior to standard analgesia for patients undergoing elective LC for symptomatic cholelithiasis. Specifically, topical cystic plate and port-site injection with 0.25 % bupivacaine significantly reduces pain after LC.

Design: This study was designed as single-blinded PRCT.

Setting: This study was conducted in an academic medical center.

Patients And Methods: Between February and May 2010 we randomly assigned 63 patients with symptomatic cholelithiasis in a 1:1 ratio to non-opioid/opioid analgesic combinations (Control Group, n = 32) and non-opioid/opioid analgesic combinations plus topical 0.25 % bupivacaine onto the cystic plate and local 0.25 % bupivacaine port-site injection, post-LC (Study Group, n = 31). Primary endpoint was patient-reported pain 1, 4, 6, 12, 24 h and 1 week post-LC using the Visual Analog Scale (VAS 0-10).

Results: Study groups were comparable clinicopathologically. There were no adverse events. A statistically significant reduction in mean pain score was apparent in Study Group patients in comparison with Control Group (mean VAS 4.83 ± 2.33 vs. 6.80 ± 1.87; p < 0.001) at all early (1-6 h) post-operative time points following LC.

Conclusion: This PRCT shows significantly improved pain control with somatovisceral pain blockade over non-opioid/opioid analgesic combinations following LC for symptomatic cholelithiasis. For centers not utilizing adjunctive local anesthetic for LC, this topical use of bupivacaine may improve patient comfort during recovery. This trial was registered on www.ClinicalTrials.gov NCT# 01972620.

Citing Articles

Ideal Local Anesthetic for Intraperitoneal Gallbladder Bed Infiltration Following Laparoscopic Cholecystectomy: A Randomized Controlled Trial.

Ahmed S, Shabbir S, Rana N, Khatoon A, Ghani U, Basharat I Cureus. 2024; 16(10):e71122.

PMID: 39525126 PMC: 11544506. DOI: 10.7759/cureus.71122.

Analgesic efficacy of erector spinae plane block versus transversus abdominis plane block for laparoscopic cholecystectomy: a systematic review and meta-analysis of randomized controlled trial.

Zewdu D, Tantu T, Eanga S, Tilahun T Front Med (Lausanne). 2024; 11:1399253.

PMID: 39135713 PMC: 11317285. DOI: 10.3389/fmed.2024.1399253.

The Comparison of Postoperative Pain, Nausea, and Vomiting between Veress Needle Entry and Direct Trocar Entry Methods in Patients Undergoing Laparoscopic Cholecystectomy.

Toolabi K, Elyasinia F, Taftian E, Sadeghian E, Soroush A Middle East J Dig Dis. 2021; 13(1):54-60.

PMID: 34712439 PMC: 8531939. DOI: 10.34172/mejdd.2021.204.

Intraperitoneal local anaesthetic instillation versus no intraperitoneal local anaesthetic instillation for laparoscopic cholecystectomy.

Rutherford D, Massie E, Worsley C, Wilson M Cochrane Database Syst Rev. 2021; 10:CD007337.

PMID: 34693999 PMC: 8543182. DOI: 10.1002/14651858.CD007337.pub4.

Effects of single-dose preemptive intravenous ibuprofen on postoperative opioid consumption and acute pain after laparoscopic cholecystectomy.

Ahiskalioglu E, Ahiskalioglu A, Aydin P, Yayik A, Temiz A Medicine (Baltimore). 2017; 96(8):e6200.

PMID: 28225506 PMC: 5569427. DOI: 10.1097/MD.0000000000006200.

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