EFFECT OF INTRAPERITONEAL BUPIVACAINE ON PAIN AFTER LAPAROSCOPIC CHOLECYSTECTOMY

The effect of intraperitoneal bupivacaine on postoperative pain was st udied in 60 ASA 1-2 patients undergoing elective laparoscopic cholecys tectomy. The patients were randomly selected (20 patients in each grou p) to receive in double-blind fashion 100 ml of either plain 0.15% bup ivacaine (150 mg . 100 ml(-1)) or the same solution with adrenaline (1 .5 mu g . ml(-1)), or the same volume of saline into the right subdiap hragmatic space at the end of surgery. The patients Here kept in the T rendelenburg's position for 20 min after the instillation. Venous bloo d samples for the determination of bupivacaine plasma concentrations w ere drawn up to 180 min. Plasma bupivacaine concentrations peaked at 3 0 min (highest individual value 2.6 mu g ml(-1)) after instillation. B upivacaine concentrations were significantly lower in the bupivacaine- adrenaline group. During the follow-up no difference between the group s occurred as to the time to first demand of analgesia, severity of po stoperative pain, amount of consumed analgesics during 7 days, and len gth of hospitalization In all groups, 30-45% of the patients complaine d of right shoulder pain. After the first 24 hours, pain at rest and d uring moving was reported as mild and was managed with oral ketoprofen . It is concluded that postsurgical intraperitoneal instillation of 15 0 mg bupivacaine in 100 mt of saline had no effect on pain after lapar oscopic cholecystectomy.