Effect of Wound Infiltration with Bupivacaine after Laparoscopic Cholecystectomy – A Randomized, Controlled Trial

Background and Objective: Adequate post-operative pain management can improve surgical outcome. Patients undergoing surgery can be affected socially, psychologically, economically with undertreated pain. We aimed to evaluate the effect of 0.25% bupivacaine infiltration on postoperative pain, analgesic requirement, satisfaction level, hospital discharge and quality of life after laparoscopic cholecystectomy.

Methodology: Fifty eight patients undergoing laparoscopic cholecystectomy were enrolled and randomized in two groups – placebo and intervention. Patients were infiltrated with 10 ml 0.25% bupivacaine in intervention and 10 ml 0.9% normal saline in placebo group. Post-operative pain was managed with morphine using Patient Controlled Analgesia (PCA). Pain intensity was assessed on the matrix of visual analogue scale and verbal rating scale up to 12 post-operative hours. This study also assessed its effect on analgesic requirements, hospital stay, patient satisfaction level after 24hours, pain score on discharge, time taken to return to job and quality of life (on 15^th and 30^th post-operative day).

Results: It was revealed 0.25% bupivacaine can lower post-operative pain up to six post-operative hour of performing laparoscopic cholecystectomy. Total analgesic requirement was also reduced (p= 0.0003) with decreased side effect like vomiting (p= 0.0002). However, satisfaction and quality of life were not affected by bupivacaine infiltration in this study.

Conclusion: 0.25% Bupivacaine infiltration offered more effective management of postoperative analgesia with decreased analgesic requirement and less incident of vomiting. But it was not effective after long duration in terms of satisfaction level, hospital discharge, time to return to job or quality of life.