THE EFFECT AND TIMING OF LOCAL-ANESTHESIA IN LAPAROSCOPIC CHOLECYSTECTOMY

Although postoperative pain following laparoscopic cholecystectomy (LC ) is less intense than that after open surgery, postoperative morbidit y nonetheless increases with LC. The aim of this study was to investig ate whether local anesthetic infiltration of trocar sites during LC de creased postoperative pain and, if so, to find the optimum timing for local anesthesia (LA). Seventy patients undergoing LC were randomized into three groups. In the first (control group, n = 25) 3 ml of 0.9% N aCl was subcutaneously infiltrated around each 5-mm trocar site, 4 ml around each 10-mm site. In the second group (n = 20), the same volume of local anesthetic was administered in the same manner prior to surge ry, and in the third group (n = 25) an identical dose of local anesthe tic was infiltrated al the end of surgery. A visual analog scale was g iven to all patients, who were asked to record their pain intensity at 1, 3, 5, 7, and 12 h postoperatively. Pethidine HCl I mg/kg i.m. was given to those whose pain intensities were greater than 5. The mean pa in intensities were 7.6, 5.9, and 5.1 in the control, preoperative, an d postoperative LA groups, respectively, In the preoperative LA group, 50% of patients and in the postoperative LA group 28% of patients req uired analgesics compared with 76% in the control group. The main pain intensities and analgesic requirements were significantly lower in th e postoperative LA group compared with other groups. We conclude that local anesthesia during LC reduces postoperative pain and that infiltr ation of trocar sites following surgery offers better pain relief than local anesthetic given just before the incision.