International Journal of Research in Medical Sciences | December 2016 | Vol 4 | Issue 12 Page 5154 International Journal of Research in Medical Sciences Gandhi JA et al. Int J Res Med Sci. 2016 Dec;4(12):5154-5158 www.msjonline.org pISSN 2320-6071 | eISSN 2320-6012 Original Research Article To assess the role of multisite instillation of bupivacaine-xylocaine combination for reducing post-operative pain after elective laparoscopic cholecystectomy Jignesh A. Gandhi, Pravin H. Shinde*, Pratik D. Patil, Samarth A. Thakkar, Rohan D. Digarse INTRODUCTION Laparoscopic techniques have evolved rapidly over the last two decades. This mode of access offers patients the benefits of quick recovery and early return to normal activities, compared with the traditional laparotomy approach. In spite of advancements, pain is often the main factor that hinders return to normal activities. Pain following laparoscopic surgery is multifactorial, arising from trocar sites (somatic pain), operative site (visceral pain), and shoulder pain (referred from diaphragmatic irritation because of pneumo-peritoneum). Currently no standard of care exists regarding the use of local analgesia in laparoscopic surgeries. Previous clinical trials have shown controversial results with intraperitoneal and trocar site analgesia after cholecystectomy in minimizing postoperative pain. 1,2 The site of local anaesthetic instillation, timing of administration, differences in local anaesthetic dosages, and non-homogeneous delivery of analgesic solutions within the abdominal cavity all may contribute to inconsistent results. Aim of the study was to assess ABSTRACT Background: Pain following laparoscopic surgery is multifactorial, arising from trocar sites (somatic pain), operative site (visceral pain) and shoulder pain (referred from diaphragmatic irritation because of pneumo-peritoneum). Currently no standard of care exists to reduce post-operative pain by use of local analgesia in laparoscopic cholecystectomy. Despite many studies, there are contradictory results. Aim of the study was to assess whether instillation of local anaesthetics at trocar sites and intraperitoneally, reduces the amount of pain experienced in the immediate postoperative period after laparoscopic cholecystectomy. Methods: This prospective study was carried out in the Department of General Surgery in a tertiary medical Centre in Mumbai. 75 subjects were randomized into 2 groups. Group A consisting of 38 patients were subjected to multisite instillation of LA combination (bupivacaine+xylocaine) at trocar site, gall bladder fossa, sub diaphragmatic space. Group B, (control group) consisting of 37 patients was given no such LA. Post operatively, pain was assessed by VAS scale (0-100) at 1,4,24 hours. Both the groups were compared and analysed. Results: Group A showed significantly reduced pain scores at 1, 4 and 24 hours post operatively as compared to group B. Conclusions: Our results indicate that multisite infiltration of local anesthetic combination (bupivacaine+xylocaine) after laparoscopic cholecystectomy surgery significantly reduces pain at 1, 4 and 24 hours postoperatively. Keywords: Bupivacaine, Laparoscopic cholecystectomy, Multisite instillation, Postoperative pain, Xylocaine Department of General Surgery, Seth G.S. Medical College and KEM Hospital, Mumbai, India Received: 18 October 2016 Accepted: 22 October 2016 *Correspondence: Dr. Pravin Shinde, E-mail: drpravinshinde@yahoo.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20164012