Compare the Effects of Infiltration of Bupivacaine in Liver Bed with Preperitoneal Nerve Block in Laparoscopic Cholecystectomy

Abstract

Background: Laparoscopic cholecystectomy is now considered the preferred treatment for symptomatic gallstone diseases, establishing itself as the gold standard method. Nevertheless, pain remains the sole grievance responsible for delaying discharge.

Objective: To compare the effectiveness of bupivacaine infiltration into the liver bed and peritoneal cavity in reducing pain after laparoscopic cholecystectomy.

Material and Methods: This prospective comparative study was done at the Department of General Surgery of Akbar Niazi Teaching Hospital, Islamabad. The study included 100 patients who were admitted for elective laparoscopic cholecystectomy between June and November 2023.Patients were consecutively assigned to received either bupivacaine preperitoneal nerve block. After gallbladder was removed, 20 ml bupivacaine 0.5% was administered in liver bed. For preperitoneal nerve block bupivacaine 0.5% was infiltrated into port sites to block the preperitoneal nerves. Postoperative pain assessment was conducted at 1, 6, 12, and 24 hours utilizing the Visual Analog Scale (VAS).

Results: The mean patients ages were43.88±7.8 years. Postoperative mean VAS at 1, 6 and 12 hours were decreased in Bupivacaine compare to preperitoneal nerve block (p ≤ 0.05). Postoperatively no difference was observed in VAS at 24 hours between the patients (p ≥ 0.05). The total doses mean of SAID utilized in first 24 hours postoperatively were lower in Bupivacaine patients than in preperitoneal nerve block patients (p ≤ 0.05).

Conclusion: The infiltration of bupivacaine in the liver bed following laparoscopic cholecystectomy effectively reduces pain as compare to preperitoneal nerve block. This straightforward, cost-effective technique should be adopted to diminish early postoperative pain in all elective cases.