Although
postoperative pain following
laparoscopic cholecystectomy (LC) is less intense than that after open surgery, postoperative morbidity nonetheless increases with LC. The aim of this study was to investigate whether
local anesthetic infiltration of
trocar sites during LC decreased
postoperative pain and, if so, to find the optimum timing for
local anesthesia (LA). Seventy patients undergoing LC were randomized into three groups. In the first (control group, n = 25) 3 ml of
0.9% NaCl was subcutaneously infiltrated around each 5-mm
trocar site, 4 ml around each 10-mm site. In the second group (n = 20), the same volume of
local anesthetic was administered in the same manner prior to surgery, and in the third group (n = 25) an identical dose of
local anesthetic was infiltrated at the end of surgery. A visual analog scale was given to all patients, who were asked to record their
pain intensity at 1, 3, 5, 7, and 12 h postoperatively.
Pethidine HCl 1 mg/kg i.m. was given to those whose
pain intensities were greater than 5. The mean
pain intensities were 7.6, 5.9, and 5.1 in the control, preoperative, and postoperative LA groups, respectively. In the preoperative LA group, 50% of patients and in the postoperative LA group 28% of patients required
analgesics compared with 76% in the control group. The main
pain intensities and
analgesic requirements were significantly lower in the postoperative LA group compared with other groups. We conclude that
local anesthesia during LC reduces
postoperative pain and that infiltration of
trocar sites following surgery offers better
pain relief than
local anesthetic given just before the incision.