A Prospective Study on Local Anaesthetic Infiltration for Postoperative Pain Relief After Laparoscopy

BACKGROUND surgery is a modern surgical technique in which operations are performed through small incisions and with the aid a camera. Pain is the most common complaint following any surgery, but as compared to open surgery, the severity of pain much lower in patients undergoing surgery via laparoscopy. The pain following laparoscopic procedure can be divided into components- parietal pain, visceral pain and shoulder pain. The use of local long-acting anaesthetics reduces postoperative pain. In this study, we tested the hypothesis that local anaesthetics instilled at the end of laparoscopic procedure are to prevent postoperative pain during the first 24 hours post-surgery. The outcome measures were pain scores, analgesic and time to analgesic request. AND METHODS was a prospective study conducted by the surgical department, Pondicherry Institute of Medical Sciences for a period of 13 months. The study comprised of 50 patients with an ASA I or II who underwent laparoscopic procedures between April 2016 May 2017. Patients in this study were randomly categorised equally into two groups; in the study group (Group A) patients local anaesthetic infiltration with bupivacaine, while in the control group (Group B), patients did not receive local infiltration. Following history taking and physical examination, patients were subjected to routine laboratory and ultrasonogram. Contrast-enhanced computerised tomography was done in patients when indicated and which patients diagnosed with acute appendicitis or who had symptomatic cholelithiasis were taken up for laparoscopic . In the study group, local anaesthetic was instilled at the end of surgery after port removal. The total volume of solution in the study group was 10 mL divided proportionally according to the length of the skin incisions (3 mL for 10 mm incisions and 2 mL for 5 mm). The outcomes were then measured. Pain was measured using visual analogue score patients were to verbally rate the pain into no pain = 0, light = 1, moderate = 2 or severe = 3. Pain scores were recorded the third, sixth and twenty-four hours post-surgery. The time from wakeup post general anaesthesia to time of analgesic was recorded. Postoperative pain for the first 24 hours was managed with the use of tramadol in a dose of 50 mg , which was provided based on pain score. Data was collected in a prospective manner and were analysed and with other studies. Data charting was done using MS Excel 2010. total of 50 patients were included in the study of which 22 were laparoscopic cholecystectomy and 28 were laparoscopic . The analgesic dosing requirement for patients who did not receive local anaesthetic infiltration was found to higher. Pain scores at the third, sixth and twenty-four hours following surgery using visual analogue scores suggested patients had local port site infiltration with bupivacaine had better pain relief. The overall outcome with regard to pain management patients undergoing laparoscopic procedure were found to be favourable with the usage of a long-acting local anaesthetic in this study bupivacaine. report that though pain is the most common complaint following a laparoscopic procedure, it can be managed to a certain with the use of a long-acting local anaesthetic. In both groups, pain was recorded, but in the study group where was used. It was found to be effective in managing port site pain as evidenced by visual analogue scores. Since, incisional pain dominated throughout the first twenty-four hours, longer lasting local anaesthetics producing analgesia for days maybe desirable.