RANDOMIZED TRIAL OF PERIPORTAL PERITONEAL BUPIVACAINE FOR PAIN RELIEFAFTER LAPAROSCOPIC CHOLECYSTECTOMY

The aim of this study was to determine whether injection of a long-act ing local anaesthetic, in relation to the port sites at the level of t he parietal peritoneum, would reduce postoperative pain following lapa roscopic cholecystectomy. Patients were entered into a randomized, pro spective, double-blind study comparing the effects of a standard techn ique, in which bupivacaine (total of 20 ml, 0.5 per cent) was injected into the subcutaneous periportal tissue around the four port sites, a nd a technique in which bupivacaine (total of 20 mi, 0.25 per cent) wa s injected into the subcutaneous periportal tissue as above with the a ddition of periportal parietal peritoneal injection of bupivacaine (to tal of 20 mi, 0.25 per cent). Two scores for pain, with the patient at rest, and on movement, were assessed 6 and 18 h after surgery using a visual analogue pain scale. Median pain score was significantly highe r in patients who received standard technique (n = 40) than in those g iven peritoneal injection (n = 40) at both 6 (rest = 3.0 versus 1.0, m ovement = 5.0 versus 2.9) and 18 h (rest = 1.9 versus 0, movement = 3. 2 versus 1.2). Both opiate and oral analgesic requirements were reduce d in patients administered peritoneal injection, although this was not statistically significant. The addition of periportal injection of bu pivacaine at the level of the parietal peritoneum, performed under dir ect vision, reduces pain after laparoscopic cholecystectomy.