Liver Bed Infiltration With Isobaric Levobupivacaine Versus Intravenous Paracetamol Analgesia for Postoperative Pain Management in Patients Undergoing Laparoscopic Cholecystectomy

Objectives The study aimed to compare the use of isobaric levobupivacaine for liver bed infiltration and intravenous analgesia with paracetamol (acetaminophen) in managing postoperative pain in patients undergoing laparoscopic cholecystectomy. Methods An observational study was conducted on 80 patients scheduled for elective laparoscopic cholecystectomy. Inclusion criteria comprised adults of American Society of Anesthesiologists grade I, aged 18-65, undergoing elective surgeries. Exclusion criteria were contraindications to local anesthetics, history of chronic pain disorders, or ongoing opioid therapy. Participants were divided into two groups: Group LB receiving 30-40 ml 0.5% isobaric levobupivacaine for liver bed infiltration, and Group P receiving paracetamol 1 g intravenous during surgery just after removing the gallbladder out of the laparoscopic port. Primary outcomes included pain scores assessed using the visual analog scale (VAS) at one hour, six hours, 12 hours, 18 hours, and 24 hours postoperatively. Secondary outcomes included the total analgesic consumption, patient satisfaction scores, and any adverse effects experienced. Results In Group LB, the VAS scores showed a declining trend, starting at 6.4 ± 0.8 at one hour and decreasing to 4.5 ± 1.5 at six hours, 4.1 ± 1.7 at 12 hours, 2.6 ± 1.3 at 18 hours, and 1.3 ± 0.6 at 24 hours. In Group P, the VAS scores also decreased, beginning at 7.2 ± 1.1 at one hour, then dropping to 5.2 ± 1.2 at six hours, 4.8 ± 1.1 at 12 hours, 3.2 ± 0.9 at 18 hours, and 1.8 ± 0.5 at 24 hours. However, statistically, VAS scores were significantly lower in Group LB as compared to Group P at all time points: one hour, six hours, 12 hours, 18 hours, and 24 hours (p<0.05). Group LB demonstrated significantly better outcomes compared to Group P, including a longer time to first rescue analgesia (12 vs. five hours, p<0.0001), a reduced dose of additional analgesic requirement (3 ± 1 vs. 6 ± 2 µg/kg, p<0.0001), and higher patient satisfaction (38 (95%) vs. 23 (57.5%), p=0.0001). The incidence of nausea (3 (7.5%) vs. 6 (15%), P=0.481) and vomiting (5 (12.5%) vs. 8 (20%), p=0.363) was comparable between Group LB and Group P. Conclusion The use of levobupivacaine for liver bed infiltration provided adequate pain relief following laparoscopic cholecystectomy in comparison to paracetamol intravenous analgesia. Side effects like nausea and vomiting were statistically comparable in both groups. Overall, levobupivacaine for liver bed infiltration is a safe and effective option for controlling pain and increasing satisfaction among patients undergoing laparoscopic cholecystectomy.