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Pain after laparoscopic cholecystectomy: the effect and timing of incisional and intraperitoneal bupivacaine

[La douleur post-cholécystectomie laparoscopique : l'effet et la chronologie de l'administration de bupivacaïne incisionnelle et intrapéritonéale]

Il-Ok Lee , MD PhD^*, Sun-Han Kim , MD PhD, Myung-Hoon Kong , MD PhD^*, Mi-Kyung Lee, MD PhD^*, Nan-Sook Kim , MD PhD^*, Young-Seok Choi, MD PhD^* and Sang-Ho Lim , MD PhD^*

^* From the Department of Anesthesia, College of Medicine, Korea University; Korea University Guro Hospital, Seoul, and the
Department of General Surgery, Korea University Ansan Hospital, Kyongki-do, South Korea.

Address correspondence to: Dr. Myung-Hoon Kong, Department of Anesthesia, Korea University Guro Hospital, 80 Guro-dong, Guro-ku, Seoul 152-703, South Korea. Phone: 82-2-818-6205; Fax: 82-2-851-1180; E-mail: iloklee{at}hotmail.com

Purpose: To examine the combined preemptive effects of somato-visceral blockade during laparoscopic cholecystectomy (LC).

Methods: One hundred fifty-seven patients under general anesthesia receiving local infiltration and/or topical peritoneal local anesthesia were studied. Patients were randomized to receive a total of 150 mg (0.25% 60 mL) bupivacaine via periportal (20 mL) and intraperitoneal (40 mL with 1:200,000 epinephrine) administration of each. Group A received preoperative periportal bupivacaine before incision and intraperitoneal bupivacaine immediately after the pneumoperitoneum. Group B received periportal and intraperitoneal bupivacaine at the end of the operation. Group C (preoperative) and Group D (postoperative) received only periportal bupivacaine and Group E (preoperative) and Group F (postoperative) received only intraperitoneal bupivacaine. The control group received no treatment. Pain and nausea were recorded at one, two, three, six, nine, 12, 24, 36, and 48 hr postoperatively.

Results: Throughout the postoperative 48 hr, incisional somatic pain dominated over other pain localizations in the control group (P <0.05). The incisional pain of groups A, B, C and D was significantly lower than that of the control group in the first and second hours. The incisional pain of groups A and C was significantly lower than that of the control group in the first three hours.

Conclusion: Incisional pain dominated during the first two postoperative days after LC. Preoperative somato-visceral or somatic local anesthesia reduced incisional pain during the first three postoperative hours. A combination of somato-visceral local anesthetic treatment did not reduce intraabdominal pain, shoulder pain or nausea more than somatic treatment alone. Preoperative incisional infiltration of local anesthetics is recommended.

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