INTRODUCTION The economic and health impact of cholelithiasis is significant due to its high morbidity. Since the introduction of laparoscopic cholecystectomy in the early 90s, which is considered a safe treatment for cholelithiasis, a possible unjustified increase in 1 surgical procedures has been observed . The incidence of symptomatic cholelithiasis is reported to be 2.2/1000 USA population with more than 500,000 cholecystectomies performed 2 yearly . Many studies have demonstrated the safety, feasibility and cost effectiveness of laparoscopic cholecystectomy as a day care 3 procedure . The type of pain after laparoscopic surgery differs considerably from that seen after laparotomy. Whereas laparotomy results mostly in parietal pain, patients after laparoscopic cholecystectomy complain more of visceral pain results from the stretching of intra-abdominal cavity, peritoneal inflammation and phrenic nerve irritation caused by residual carbon dioxide in the peritoneal cavity. Postoperative pain due to cholecystectomy may be transient and most of the time it lasts for 24 hours but may extend up to 3 days. Immediately after surgery, the intensity of pain is more in the first 24 hours and then decreases gradually. In comparison to open cholecystectomy, the intensity of post operative pain is less after laparoscopic cholecystectomy, but there will still be moderate to severe pain and other complications like nausea and vomiting in the first 4 24 hours . Moreover shoulder tip and back pain ORIGINAL PROF-2492 The Professional Medical Journal www.theprofesional.com LAPAROSCOPIC CHOLECYSTECTOMY; The effect of intraperitoneal instillation of bupivacaine on the mean post-operative pain scores 1 2 3 4 Dr. Ayaz Gul , Dr. Imtiaz Khan , Dr. Ahmad Faraz , Dr. Irum Sabir Ali ABSTRACT… Introduction: Laparoscopic cholecystectomy is the treatment of choice for symptomatic cholelithiasis. Intraperitoneal instillation of bupivacaine is one of the methods used to improve pain relief after laparoscopic cholecystectomy. Objective: To compare the mean pain score after intraperitoneal instillation of bupivacaine with placebo during laparoscopic cholecystectomy. Study Design: Randomized Control trial. Setting: This study was carried out a surgical unit PGMI Lady Reading Hospital and Hayatabad Medical Complex, Peshawar. Duration: The duration of study was 6 months from 15th May to 15th December, 2013. Subjects and Methods: 92 patients in each group were included in study to compare the mean pain score of intraperitoneal instillation of bupivacaine (Group A; study group) with 0.9% normal saline solution (Group B; placebo group) using visual analogue scale after laparoscopic cholecystectomy at 12th hour after surgery. Data was entered in software SPSS version 16.0. T test was used to compare the mean pain scores. Results: The mean age of patients in Group A and B was 41.82 ± 7.34 and 40.95 ± 9.24 respectively (p=0.483). Group A has low mean pain score (3.619 ± 0.676) according to Visual Analogue Scale then Group B (3.837 ± 0.667) with a statistically significant p value (p=0.036). A t test failed to reveal a statistically reliable difference between gender (p=0.513) and age (p=0.767) wise distribution of mean pain between group A and B. Conclusions: Mean pain score of intraperitoneal instillation of bupivacaine is significantly less than 0.9% normal saline solution at 12th hour after laparoscopic cholecystectomy. Key words: Intraperitoneal Instillation; Mean Pain Score; Laparoscopic Cholecystectomy. Article Citation: Gul A, Khan I, Faraz A, Ali IS. Laparoscopic Cholecystectomy; The effect of intraperitoneal instillation of bupivacaine on the mean post-operative pain scores. Professional Med J 2014;21(4): 593-600 1. (MBBS, FCPS) Senior Registrar, Surgical C Unit, Lady Reading Hospital, Peshawar 2. (MBBS) T.M.O, Department of Surgery, Hayatabad Medical Complex, Peshawar. 3. (MBBS, FCPS) Registrar, Surgical C Unit, Lady Reading Hospital, Peshawar 4. (MBBS, MRCSEd) TMO, Surgical C Unit, Lady Reading Hospital, Peshawar Article received on: 14/04/2014 Accepted for Publication: 23/07/2014 Received after proof reading: 16/08/2014 Correspondence Address: Dr. Ahmad Faraz Surgical C Unit Department Of Surgery, Govt. PGMI, Lady Reading Hospital Peshawar. drahmadfaraz_79@yahoo.co.uk www.theprofesional.com 593 Professional Med J 2014;21(4): 593-600.