Intraperitoneal local anaesthetics via subphrenic catheter following laparoscopic cholecystectomy: pain relief and pulmonary function

Pain and pulmonary impairment continue to be major issues in the postoperat ive management of daycare laparoscopic cholecystectomy. 33 patients undergo ing laparoscopic cholecystectomy were randomly assigned to one of two group s of postoperative pain management. The first group received prilocaine and bupivacaine via a subphrenic catheter inserted through a trocar incision a t the end of laparoscopy. The second group received i.v. piritramid on requ est. Pain and alertness' were assessed by visual analogue scales, pulmonary function by bedside spirometry and arterial blood gas analysis. There was no difference in pain scoring between groups, but pain relief was significa ntly faster in Group 1. No differences were found between groups in impaire d postoperative forced vital capacity and peak expiratory flow, but only Gr oup 2 patients developed hypercarbia. It is concluded that postoperative pa in relief via a subphrenic catheter is faster, equally effective and associ ated with greater alertness and no hypercarbia. Impaired pulmonary function cannot be improved when applying prilocaine and bupivacaine via the subphr enic catheter, instead of giving i.v. piritramid.