Comparison of efficacy of intraperitoneal instillation of bupivacaine alone with bupivacaine – fentanyl and bupivacaine –tramadol combination for alleviation of post-operative pain following laparoscopic cholecystectomy: a randomized prospective study

Abstract

Aim: A prospective randomized study was conducted to compare effect of bupivacaine with bupivacaine plus fentanyland bupivacaine plus tramadol, intraperitoneally for postoperative pain relief in patients undergoing laparoscopiccholecystectomy under general anaesthesia.Methods: Sixty ASA I & 2 female patients, 20-50 years, undergoing laparoscopic cholecystectomy under generalanaesthesia, were enrolled. Standard anaesthesia was administered and laparoscopic cholecystectomy was performed.At the end of successful surgery, patients were randomly assigned into group C (20 ml of 0.25% Bupivacaine, n=20),group T( 20 ml of 0.25% Bupivacaine with tramadol 2 mg/kg, n=20) and group F( 20 ml of 0.25% Bupivacaine withfentanyl 2ìg/kg, n=20).Test solution was sprayed, using catheter inserted into sub-costal trocar at upper surface ofliver and right sub-diaphragmatic space and it diffused into hepato-diaphragmatic space near and above hepatoduodenalligament and above the gall bladder. After reversal of neuromuscular blockade patients were assessed forpain using VAS score, presence of shoulder pain, number of analgesic doses and adverse effects at 30 minutes, 1, 2, 3,4, 6, 8, 12, and 24 hours postoperatively . Rescue analgesia consisted of intramuscular injection of 75mg diclofenacsodium (if VAS>4).Results: Visual analogue score in the early post-operative period was significantly lower in group T and F. At 12 and 24hours, the number of patients having shoulder pain was higher in group C.Conclusion: Intraperitoneal analgesia using local anaesthetic plus opioid is effective in the reduction of pain in earlypostoperative hours. It can be recommended in patients undergoing laparoscopic cholecystectomy.Keywords: Laparoscopic cholecystectomy; Bupivacaine; bupivacaine plus opioid