The effect of topical intraperitoneal bupivacaine on post-operative pain following laparoscopic cholecystectomy

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Abstract
Laparoscopic cholecystectomy is associated with less patient discomfort, shorter hospital stays and more rapid return to work than open cholecystectomy. Nevertheless, it is not a pain free procedure. Peritoneal irritation at the time of surgery can cause significant pain. Topical instillation of local anaesthetics reduces post-operative pain following diagnostic laparoscopy and laparoscopic tubal ligations. A similar benefit has not been demonstrated in upper abdominal laparoscopic procedures. This study was designed to assess the effect on post-operative pain of 30 cc of 0.5% bupivacaine with 1:200000 epinephrine administered at the completion of laparoscopic cholecystectomy. Laparoscopic cholecystectomy was performed on 46 patients, 23 of whom received bupivacaine and 23 received saline. Post-operative pain was assessed by reviewing nursing records and by analysis of analgesic requirements of each patient. In patients receiving bupivacaine, analgesic requirement was significantly lower at 4–8 h and 24 h post-operatively. The fraction of patients receiving bupivacaine who subjectively reported pain to nurses (10/23) was significantly less than in the control group (18/23). Patients receiving bupivacaine also had a significantly shorter hospital stay than patients in the control group (1.3 days versus 1.9 days). We conclude that topical administration of bupivacaine at the completion of laparoscopic cholecystectomy diminishes post-operative pain and decreases hospital stay. Long-acting local anaesthetics provide significantly increased post-operative pain control when administered at the completion of laparoscopic procedures.