Abstract

Background: Laparoscopic cholecystectomy (LC) has become the gold standard for treatment of benign Gall Bladder disease. Pain after laparoscopic surgery though primarily visceral, often affecting the sub diaphragmatic region and often referred to the right shoulder region, also has a parietal component which occurs at the trocar site. The present study was planned to evaluate the effect of combined port site levobupivacaine administration before and after surgery for patients who underwent Laparoscopic cholecystectomy.
Material & Methods: This was a hospital based prospective randomized double blind comparative study done on 100 patients undergoing elective laparoscopic cholecystectomy surgery at Jawahar Lal Nehru Hospital, Ajmer, after approval from ethical committee. The study population were randomly divided into two groups A (Preincisional) and B (Post incisional) with 50 patients in each group using computer generated tables of random numbers. The primary outcome variable was to compare pain (visual analogue scale [VAS]) score. The intensity of post-operative pain was recorded for all the patients using VAS score at 3, 6, 12, 24 h after surgery (mean of all VAS scores).
Results: Our study showed that mean age of patients in group A was 43.20 years and 41.16 years in group B, which was statistical non-significant (P=0.435). There was significant difference in the mean VAS scores between the two groups up to 12^th hour postoperatively. There was statistically lower VAS score in group A as compared to group B postoperatively up to 12 hour at 24^th postoperative hour there was no significant difference in VAS score in both groups. The mean duration of analgesia was 164.94 ± 27.37 min in group A with a range of 95 to 210 min., while in group B, the mean duration of analgesia was 121.42 ± 14.81 min. with a range of 85 to 145 min, which was statistically longer in Group A as compared to Group B, (p value < 0.0001). Mean number of doses required in group A was 1.70 ± 0.46 and in group B was 2.38 ± 0.49, which was statistically higher in group B (p value <0.0001). In group A total amount of tramadol required in 24 hours was 170.00 ± 46.29 mg in comparison to group B where it was 238.00 ± 49.03 mg (p value <0.0001).
Conclusion: We concluded thatlevobupivacaine can be safely used as local anesthetic infiltration for postoperative pain relief following laparoscopic cholecystectomy surgery.