Title: Intraperitoneal Hydrocortisone plus Bupivacaine Administration for Pain Relief after Laparoscopic Cholecystectomy, a Comparison with Bupivacaine Alone
Authors: Ashvin R Kankotiya, Digant Patel
DOI: http://dx.doi.org/10.18535/jmscr/v4i9.40
Background: Laparoscopic Cholecystectomy (LC) has become the gold standard for treatment of benign Gall Bladder disease. Laparoscopy provides many benefits over conventional open procedures including faster recovery time, shorter hospital stay, less pain, and in some cases, fewer complications. Post Operative pain management has an important role in preventing the postoperative morbidity and its consequences. This study is designed to evaluate the effect of intraperitoneal instillation of bupivacaine with hydrocortisone in comparison to bupivacaine alone for pain relief following laparoscopic Cholecystectomy. Aim and Objectives: To compare the effect of intraperitoneal instillation of bupivacaine with Hydrocortisone versus Bupivacaine alone for post-operative analgesia in laparoscopic Cholecystectomy. Methods: This study includes Laparoscopic Cholecystectomy conducted in the department of General Surgery at the Sir Sayajirao General Hospital & Medical College Baroda during a period of 12 months from January 2015 to December 2015. The patients were randomized into two groups by envelop method. Assessment of the pain was done & its intensity was recorded on VAS (visual Analogue scale) after 0hrs, 6 hrs, 12hrs & 24hrs of surgery. Results: Total 50 patients were studied. Each group contain 25 patients. Bupivacaine with hydrocortisone instillation shows significant reduction in VAS Score at 6hr,12 hr and 24hr (2.40, 3.28 and 4.00) as compare to bupivacaine alone (3.24 ,4.28 and 5.04) and it is statistically significant as p value is <0.05 (0.0039,0.0026 and 0.0046) While reduction in VAS Score at o hr (1.08 and 1.48) is not statistically significant as p value is > 0.05 (0.3950). Conclusion: Intraperitoneal preoperative pre-emptive instillation of hydrocortisone with bupivacaine in laparoscopic Cholecystectomy significantly reduce post operative pain at 6 hr,12 hr and 24hr but not at 0 hr, in comparison to bupivacaine alone. Keywords: Laparoscopic Cholecystectomy (LC), Visual Analogue scale (VAS). 1. Paul FW. The changing role of non-opioid analgesic techniques in the management of postoperative pain. Anesth Analg 2005;101: 5-22. 2. Kehlet H, Dahl JB. Anesthesia, surgery and challenges in postoperative recovery. Lancet 2003;362: 1921–8. 3. Barczynski M, Konturek A, Herman RM, Superiority of pre-emptive analgesia with intraperitoneal instillation of Bupivacaine before rather than after the creation of pneumoperitoneum for laparoscopic Cholecystectomy: a randomized, double-blind, placebo-controlled study. Surg Endosc 2005; 20: 1088–1093. 4. Maestroni U, Sortini, Devito C, Pour Morad Kohan Brunaldi F, Anania G, Pavanelli L, Pasqualucci A, Donini AA new method of pre-emptive analgesia in laparoscopic Cholecystectomy: a randomized, double-blind, placebo-controlled study. Surg Endosc 2OO2; 16: 1336–1340. 5. Pascqualucci A, Angelis DV, Contardo R, Colo F, Terrosu G, Donini A, Pasetto A, Bresadola F, Pre-emptive analgesia: A randomized, double-blind, placebo-controlled study. Anesthesiology 1996; 85: 11–20. 6. Coughlin SM, Karanicolas PJ, Heather MA, Bilge Kanbur, Savas Kanbur, Colquhoun PHD. Better late than never? Impact of local analgesia timing on postoperative pain in laparoscopic surgery: a systemic review and meta analysis. Surg Endosc 2010; 24: 3167–3176. 7. Lee IO, Kim SH, Kong MH, Lee MK, Kim NS, Choi YS, Lim SH. Pain after laparoscopic Cholecystectomy: the effect and timing of incisional and intraperitoneal Bupivacaine. Can J Anaesth 2001; 48:545–550. 8. Mixter CG, Hackett TR. Pre-emptive analgesia in the laparoscopic patient. Surg Endosc 1997; 11:351–353. 9. Moiniche S, Jorgensen H, Wetterslev J, and Dahl JB. Local Anaesthetic Infiltration for Postoperative Pain Relief after Laparoscopy. Anesth Analg 2000; 90:899–912. 10. Kahokehr A, Sammour T, Soop M, Hill AG. Intraperitoneal use of local anaesthetic laparoscopic Cholecystectomy: systematic review and meta 11. Stahn C, Buttgereit F. genomic and nongemomic effect of glucocorticoids. Nat Clin Pract Rheumatol. 2008 oct;4(10):525-33. 12. Mirzai H, Tekin I, Alincak H. Perioperative use of corticosteroid and bupivacaine combination in lumbar disc surgery;a randomized controlled trial. Spine(Phila pa 1976).2002;27(4):343-6. 13. Stan T, Goodman EJ, Holbrook CR. Adding methylprednisolone to local anesthetic increase the duration of axillary block. Reg Anesth Pain Med. 2004; 29(4);380-1. Abstract
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