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

Il Ok Lee, Sun Han Kim, Myounghoon Kong, Mi Kyoung Lee, Nan Sook Kim, Young Seok Choi, Sang Ho Lim

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Abstract

Purpose: To examine the combined preemptive effects of somatovisceral blockade during laparoscopic cholecystectomy (LC). Methods: One hundred fifty-seven patients under general anesthesia receiving local infiltration and/or topical peritoneal local anesthesia were studied. Patients were randomized to receive a total of 150 mg (0.25% 60 mL) bupivacaine via periportal (20 mL) and intraperitoneal (40 mL with 1:200,000 epinephrine) administration of each. Group A received preoperative periportal bupivacaine before incision and intraperitoneal bupivacaine immediately after 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 (preoperative) 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 dominated over other pain localizations in the control group (P<0.05). The incisional 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 first three hours. Conclusion: Incisional pain dominated during the first two postoperative days after LC. Preoperative somato-visceral or somatic local anesthesia reduced incisional pain during the first three postoperative hours. A combination of somato-visceral local anesthetic treatment did not reduce intraabdominal pain, shoulder pain or nausea more than somatic treatment alone. Preoperative incisional infiltration of local anesthetics is recommended.

Original languageEnglish
Pages (from-to)545-550
Number of pages6
JournalCanadian Journal of Anesthesia
Volume48
Issue number6
DOIs
Publication statusPublished - 2001 Jan 1

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Laparoscopic Cholecystectomy
Bupivacaine
Pain
Control Groups
Local Anesthesia
Local Anesthetics
Nausea
Nociceptive Pain
Shoulder Pain
Pneumoperitoneum
General Anesthesia
Epinephrine
Therapeutics

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Pain after laparoscopic cholecystectomy : The effect and timing of incisional and intraperitoneal bupivacaine. / Lee, Il Ok; Kim, Sun Han; Kong, Myounghoon; Lee, Mi Kyoung; Kim, Nan Sook; Choi, Young Seok; Lim, Sang Ho.

In: Canadian Journal of Anesthesia, Vol. 48, No. 6, 01.01.2001, p. 545-550.

Research output: Contribution to journalArticle

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abstract = "Purpose: To examine the combined preemptive effects of somatovisceral blockade during laparoscopic cholecystectomy (LC). Methods: One hundred fifty-seven patients under general anesthesia receiving local infiltration and/or topical peritoneal local anesthesia were studied. Patients were randomized to receive a total of 150 mg (0.25{\%} 60 mL) bupivacaine via periportal (20 mL) and intraperitoneal (40 mL with 1:200,000 epinephrine) administration of each. Group A received preoperative periportal bupivacaine before incision and intraperitoneal bupivacaine immediately after 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 (preoperative) 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 dominated over other pain localizations in the control group (P<0.05). The incisional 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 first three hours. Conclusion: Incisional pain dominated during the first two postoperative days after LC. Preoperative somato-visceral or somatic local anesthesia reduced incisional pain during the first three postoperative hours. A combination of somato-visceral local anesthetic treatment did not reduce intraabdominal pain, shoulder pain or nausea more than somatic treatment alone. Preoperative incisional infiltration of local anesthetics is recommended.",
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AU - Kim, Nan Sook

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N2 - Purpose: To examine the combined preemptive effects of somatovisceral blockade during laparoscopic cholecystectomy (LC). Methods: One hundred fifty-seven patients under general anesthesia receiving local infiltration and/or topical peritoneal local anesthesia were studied. Patients were randomized to receive a total of 150 mg (0.25% 60 mL) bupivacaine via periportal (20 mL) and intraperitoneal (40 mL with 1:200,000 epinephrine) administration of each. Group A received preoperative periportal bupivacaine before incision and intraperitoneal bupivacaine immediately after 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 (preoperative) 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 dominated over other pain localizations in the control group (P<0.05). The incisional 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 first three hours. Conclusion: Incisional pain dominated during the first two postoperative days after LC. Preoperative somato-visceral or somatic local anesthesia reduced incisional pain during the first three postoperative hours. A combination of somato-visceral local anesthetic treatment did not reduce intraabdominal pain, shoulder pain or nausea more than somatic treatment alone. Preoperative incisional infiltration of local anesthetics is recommended.

AB - Purpose: To examine the combined preemptive effects of somatovisceral blockade during laparoscopic cholecystectomy (LC). Methods: One hundred fifty-seven patients under general anesthesia receiving local infiltration and/or topical peritoneal local anesthesia were studied. Patients were randomized to receive a total of 150 mg (0.25% 60 mL) bupivacaine via periportal (20 mL) and intraperitoneal (40 mL with 1:200,000 epinephrine) administration of each. Group A received preoperative periportal bupivacaine before incision and intraperitoneal bupivacaine immediately after 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 (preoperative) 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 dominated over other pain localizations in the control group (P<0.05). The incisional 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 first three hours. Conclusion: Incisional pain dominated during the first two postoperative days after LC. Preoperative somato-visceral or somatic local anesthesia reduced incisional pain during the first three postoperative hours. A combination of somato-visceral local anesthetic treatment did not reduce intraabdominal pain, shoulder pain or nausea more than somatic treatment alone. Preoperative incisional infiltration of local anesthetics is recommended.

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