Evaluation of Intraperitoneal Instillation Combined with Port-Site Infiltration of 0.5% Bupivacaine for Postoperative Pain Management in Laparoscopic Cholecystectomy: A Prospective Randomized Controlled Trial

Background: Postoperative pain after laparoscopic cholecystectomy is predominantly visceral in the first 24 hours and is conventionally managed with systemic analgesics that carry opioid-related adverse effects. Intraperitoneal instillation of a long-acting local anaesthetic targets visceral pain at its source. Aims and Objective: To evaluate the efficacy and safety of intraperitoneal instillation of 0.5% bupivacaine combined with port-site infiltration in reducing postoperative pain and analgesic requirement after elective laparoscopic cholecystectomy. Materials and Methods: In this prospective randomized controlled trial, 120 adults (American Society of Anesthesiologists class I–II) undergoing elective laparoscopic cholecystectomy were randomized to receive 20 mL of 0.5% bupivacaine instilled intraperitoneally over the gallbladder bed, hepatic surface and subdiaphragmatic space together with 10 mL infiltrated at the port sites at the end of surgery (n=60), or standard care without local anaesthetic (n=60). Patients and outcome assessors were blinded to allocation. Pain was assessed on a visual analogue scale (VAS) at 6, 12 and 24 hours. Time to first rescue analgesia, 24-hour opioid, non-steroidal anti-inflammatory drug (NSAID) and paracetamol consumption, adverse effects and satisfaction were recorded. Results: Mean VAS was lower in the bupivacaine group at 6 h (3.43±1.75 vs 6.88±0.99), 12 h (4.27±1.22 vs 7.82±1.46) and 24 h (3.80±0.40 vs 6.38±0.52; all p<0.001). Rescue analgesia was required by 15.0% versus 100% of patients (p<0.001), the time to first rescue analgesia among those who required it was longer (7.14±2.25 vs 1.70±0.74 h; p<0.001), and 24-hour opioid consumption was lower (5.83±16.19 vs 40.83±19.51 mg; p<0.001). Nausea, vomiting and shoulder pain were less frequent and satisfaction was higher (p=0.014) with bupivacaine; no hypotension, arrhythmia or local anaesthetic toxicity occurred. Conclusion: Intraperitoneal instillation of 0.5% bupivacaine combined with port-site infiltration is a simple, safe and effective addition to multimodal analgesia after laparoscopic cholecystectomy.