PREINCISIONAL LOCAL-ANESTHESIA WITH BUPIVACAINE AND PAIN AFTER LAPAROSCOPIC CHOLECYSTECTOMY - A DOUBLE-BLIND RANDOMIZED CLINICAL-TRIAL

The aim of this study was to investigate whether local anesthesia of a bdominal wall wounds prior to laparoscopic cholecystectomy leads to de creased pain beyond the immediate postoperative period and thus improv es the comfort of the patient. In a randomized, double-blind study 50 patients scheduled for laparoscopic cholecystectomy were divided into two groups. In one group (n = 25) the skin, subcutis, fascia, muscle, and preperitoneal space were infiltrated with 8 ml of bupivacaine 0.5% 5 min before each abdominal wall incision. The control group (n = 25) received normal saline. The intensity of pain was assessed by a 100-p oint visual analogue scale (VAS) at rest and during movement and by th e consumption of analgesics. Analgesic therapy was provided by on-dema nd analgesia with piritramid intravenously for 24 h and continued by i buprofen orally on request. The mean intensity of pain at rest and dur ing movement was lower but not statistically significant in patients w ho received bupivacaine compared to the control group up to the second postoperative day. The difference was between 4 and 9 VAS points and therefore of doubtful clinical relevance. Similar statistically nonsig nificant results were found for the mean consumption of piritramid up to 16 h after the operation. Three patient's (12%) in the bupivacaine group localized the most severe pain up to the second postoperative da y to the right lower abdominal wall wound where the gallbladder had be en extracted compared to 11 patients (44%) of the control group (P = 0 .012). These results indicate that bupivacaine was effective at the si te where it was administered. However, preincisional local anesthesia of the abdominal wall wounds in laparoscopic cholecystectomy does not lead to a significant clinical benefit for the patient.