Pain after laparoscopic cholecystectomy: the effect and timing of incisional and intraperitoneal bupivacaine

Purpose: To examine the combined preemptive effects of somatovisceral block ade during laparoscopic cholecystectomy (LC). Methods: One hundred fifty-seven patients under general anes thesia receivi ng local infiltration and/or topical peritoneal local anesthesia were studi ed. Patients were randomized to receive a total of 150 mg (0.25% 60 mL) bup ivacaine via periportal (20 mL) and intraperitoneal (40 mL with 1:200,000 e pinephrine) administration of each. Group A received preoperative periporta l bupivacaine before incision and intraperitoneal bupivacaine immediately a fter the pneumoperitoneum. Group B received periportal and intraperitoneal bupivacaine at the end of the operation. Group C (preoperative) and Group D (postoperative) received only periportal bupivacaine and Group E (preopera tive) and Group F (postoperative) received only intraperitoneal bupivacaine . The control group received no treatment. Pain and nausea were recorded at one, two, three, six, nine, 12, 24, 36, and 48 hr postoperatively. Results: Throughout the postoperative 48 hr, incisional somatic pain domina ted over other pain localizations in the control group (P <0.05). The incis ional pain of groups A, B, C and D was significantly lower than that of the control group in the first and second hours. The incisional pain of groups A and C was significantly lower than that of the control group in the firs t three hours. Conclusion: Incisional pain dominated during the first two postoperative da ys after LC. Preoperative somato-visceral or somatic local anesthesia reduc ed incisional pain during the first three postoperative hours. A combinatio n of somato-visceral local anesthetic treatment did not reduce intraabdomin al pain, shoulder pain or nausea more than somatic treatment alone. Preoper ative incisional infiltration of local anesthetics is recommended.