Evaluation of Intraperitoneal Instillation Combined with Port-Site Infiltration of 0.5% Bupivacaine for Postoperative Pain Management in Laparoscopic Cholecystectomy: A Prospective Randomized Controlled Trial

Background

Postoperative pain after laparoscopic cholecystectomy is predominantly visceral in the first 24 hours and is conventionally managed with systemic analgesics that carry opioid-related adverse effects. Intraperitoneal instillation of a long-acting local anaesthetic targets visceral pain at its source. Aims and Objective: To evaluate the efficacy and safety of intraperitoneal instillation of 0.5% bupivacaine combined with port-site infiltration in reducing postoperative pain and analgesic requirement after elective laparoscopic cholecystectomy. Materials and Methods: In this prospective randomized controlled trial, 120 adults (American Society of Anesthesiologists class I–II) undergoing elective laparoscopic cholecystectomy were randomized to receive 20 mL of 0.5% bupivacaine instilled intraperitoneally over the gallbladder bed, hepatic surface and subdiaphragmatic space together with 10 mL infiltrated at the port sites at the end of surgery (n=60), or standard care without local anaesthetic (n=60). Patients and outcome assessors were blinded to allocation. Pain was assessed on a visual analogue scale (VAS) at 6, 12 and 24 hours. Time to first rescue analgesia, 24-hour opioid, non-steroidal anti-inflammatory drug (NSAID) and paracetamol consumption, adverse effects and satisfaction were recorded.