ORIGINAL ARTICLE P J M H S Vol. 9, NO. 1, JAN – MAR 2015 375 Efficacy of Intra-peritoneal Bupivacaine for Analgesia in Early Post-operative Period After Laparoscopic Cholecystectomy NISAR AHMED, RIAZ HUSSAIN, TAHIR NAZEER ABSTRACT Aim: To compare the efficacy of intra-peritoneal bupivacaine (25%) in early post-operative period after laproscopic cholecystectomy with a control group. Study Design: Randomized Control trial. Method: 120 patients undergoing for laparoscopic cholecystectomy were included and divided into two equal groups B and C by using random number table. Each group comprised of 60 patients. In group ‘C’ no intra-peritoneal bupivacaine was used. In group ‘B’ 20 ml of ( .25%) bupivacaine was instilled in the right sub-diaphragmatic space and at gall bladder bed. Results: Post-operative mean abdominal pain score on VAS in both groups on different intervals was calculated and recorded 1.34±0.43 (cm) in group B and 2.54±0.26 (cm) in group C at 0 hours, 2.11±0.32 (cm) in group B and 2.98±1.05 (cm) in group C at 2 hours, 2.98±1.05 (cm) in group B and 3.24±0.84 (cm) in group C at 4 hours while 3.13±1.21 (cm) in group B and 4.59±1.32 (cm) in group C at 6 hour were recorded. Comparison of Efficacy in both groups was recorded which reveals 22(36.67%) in group B and 4(6.67%) in group C while 38(63.33%) group B and 56(93.33%) in group C. Conclusion: Intra-peritoneal bupivacaine infiltration is an effective method for relief of post operative pain in laproscopic cholecystectomy. Keywords: Laparoscopic cholecystectomy, post-operative pain, intra-peritoneal bupivacaine INTRODUCTION Laparoscopic cholecystectomy is one of the most frequently performed elective surgical operations 1 . The benefits of laparoscopic cholecystectomy compared with open surgery are less post-operative pain, reduced analgesic consumption and more rapid return to normal daily activities; However post- operative pain still remain the most prevalent complaint after this type of surgery and is more common in early post-operative period 2-6 . Several analgesic interventions with varying targets and mechanisms have been used to control early post-operative pain after laparoscopic cholecystectomy 7 . Intra-peritoneal bupivacaine has been the most widely used local anaesthetic because of its long duration of analgesic action and high potency 8,9 . Pain relief after laparoscopic cholecystectomy is an issue of great practical importance 10 . Laparoscopy has become the new gold standard for the treatment of symptomatic cholelithiasis and an increasing number of procedures are done for acute cholecystitis 11,12 . MATERIAL & METHODS After the approval of study from the hospital ethics committee 120 patients undergoing laparoscopic ----------------------------------------------------------------------- Department of Anaesthesia, Services Hospital, Lahore Correspondence: Dr. Tahir Nazeer, Email: drtahirnazeer@yahoo.com cholecystectomy were included and divided into two equal groups B & C by using a random number table. Patient’s bio-data was noted. Informed consent was taken, pre-operative assessment was done a day before surgery. Enrolled patients were explained about the use of Visual Ananlogue Scale, employed in this study. In operation theater standard II monitoring was used. In all cases nalbuphine 6mg, and metochlopramide 10 mg was adminstered IV before induction of anaesthesia which was achieved by propofol and suxamethonium for intubation with endotracheal tube, maintained by using oxygen nitrous oxide and Isoflurane, muscle relaxation by Atracurium. All four incision sites were infiltrated with 5 ml of .5% bupivacaine 2 minutes before incision. Pneumo-peritonium was produced by CO 2 insufflation and pressure was maintained between 12-14mmHg. Gall bladder was delivered out through epigastric port. In group C no intraperitoneal bupivacaine was used while in group B 20 ml of bupivacaine (.25%) was instilled in the right sub- diaphragmatic space and at gall bladder bed. At the end, muscle relaxation was reversed by neostigmine and glycopyrolate.The dosage of all the anaesthetic drugs used according to the standard protocols and were the same for all patients. The time of arrival in the post-operative ward was defined as zero hour. The patients were assessed at 0, 2, 4 and 6 hours post-operatively by Visual Analogue scale (VAS) for