Ideal pain relief following laparoscopic cholecystectomy

In a previous report the effectiveness of intraperitoneal bupivacaine in re ducing pain following laparoscopic cholecystectomy was demonstrated. Other methods of pain relief are commonly used but none has been compared followi ng laparoscopic cholecystectomy. In two further studies we have compared th e analgesic effect of intraperitoneal bupivacaine against wound infiltratio n with bupivacaine, and against intraperitoneal bupivacaine with the additi on of a non-steroidal anti-inflammatory drug (NSAID) in patients undergoing laparoscopic cholecystectomy. Two consecutive studies were performed, In t he first, patients in group 1 were given 20 ml of 0.25 % bupivacaine into t he peritoneal cavity; patients in group 2 were given 20 ml of 0.25 % bupiva caine injected into the trocar wounds, In the second study, patients in gro up 1 were given 20 ml of 0.25 % bupivacaine into the peritoneal cavity; pat ients in group 2 were given 20 ml of 0.25 % bupivacaine into the peritoneal cavity and a diclofenac suppository (100 mg) one hour before surgery. Post operative pain was assessed with a visual analogue pain scale. There was no difference in pain scores in the two groups in either study. Intraperitone al bupivacaine is as effective as wound infiltration. The addition of an NS AID makes no difference in the reduction of postoperative pain following la paroscopic cholecystectomy.