In
pain control after
laparoscopic cholecystectomy, subhepatic administration of
bupivacaine immediately after the creation of
pneumoperitoneum has been shown to be more effective than administration before the withdrawal of the
trocars. We aimed to investigate the effect of intraperitoneal
bupivacaine administration to the subhepatic area before the creation of the
pneumoperitoneum. Eighty patients undergoing elective
laparoscopic cholecystectomy under
general anesthesia were included in a prospective, randomized study. Patients received 20 mL of 0.5%
bupivacaine in the subhepatic area just after intubation, before
pneumoperitoneum (group 1), immediately after the creation of the
pneumoperitoneum (group 2), just before the removal of the
trocars (group 3), or received no
local anesthetic (group 4). The degree of the
postoperative pain was assessed at 0, 4, 8, 12, and 24 hours after the surgery. The consumption of
analgesics (
diclofenac sodium) was also recorded. The
pain scores and
analgesic consumption did not differ among groups 1, 3, and 4. The
pain scores of group 2 were lower at each time point compared to the other groups (P < 0.001). Postoperative
analgesic consumption in group 2 was reduced compared to the other groups (23.4 +/- 35.9 mg vs. 80.0 +/- 66.3 mg, P = 0.005 [group 1], 69.6 +/- 62.2 mg, P = 0.026 [group 3], and 70.0 +/- 59.9 mg, P = 0.022 [group 4]). The subhepatic infiltration of 20 mL of 0.5%
bupivacaine offers good postoperative
analgesia when applied just after the creation of the
pneumoperitoneum, not before the
pneumoperitoneum or after the termination of the
pneumoperitoneum.