Post-Laparoscopic Cholecystectomy Pain: Effects of Preincisional Infiltration and Intraperitoneal Levobupivacaine 0.25% on Pain Control-a Randomized Prospective Double-Blinded Placebo-Controlled Trial.

Objective: The aim of this study was to compare the postoperative analgesic efficacy of preincisional and intraperitoneal levobupivacaine or normal saline in patients undergoing laparoscopic cholecystectomy.

Methods: Sixty patients who participated in the study were randomly divided into 3 groups. Group 1 received intraperitoneal levobupivacaine (0.25% 40 mL) immediately after the pneumoperitoneum. Group 2 received periportal levobupivacaine (0.25% 5 mL in each trochar incision area) before incision and intraperitoneal levobupivacaine (0.25% 40 mL) immediately after the pneumoperitoneum. Group 3 received for periportal and intraperitoneal instillation of normal saline. The visual analog scale (VAS) at 0, 1, 2, 4, 8, 12 and 24 hours for both shoulder and abdominal pain were recorded. Analgesia requirements and incidence of nausea and vomiting were also recorded.

Results: There were no difference between the groups for demographic data. The pain scores were lower in Groups 1 and 2 than Group 3 (control) during rest, cough and movement (p<0.05). Rescue analgesic treatment was significantly lower in patients of Group 2 (15%) as compared with that of Groups 1 (35%) and 3 (90%) (p<0.05). The incidence of shoulder pain was significantly lower in Group 2 (25%) and Group 1 (20%) than in any of the control group patients (p<0.05).

Conclusion: The results indicated that 0.25% levobupivacaine was effective in preventing pain and the need for postoperative analgesic when intraperitoneal instillation or preincisional local infiltration in combination with intraperitoneal instillation. However, levobupivacaine for preincisional local infiltration in combination with intraperitoneal instillation is the better choice because of its higher efficacy.