Abstract

Background: Post-operative pain is a common complaint after laparoscopic cholecystectomy. The use of intraperitoneal local anaesthetic agents during laparoscopic cholecystestectomy have known to significantly alleviate this pain and reduce time to recovery. We aim to compare the use of Bupivacaine in combination with Hydrocortisone when administered in high volume low concentration solution, intraoperatively as intraperitoneal irrigation vs Bupivacaine alone, in patients undergoing elective laparoscopic cholecystectomy.
Methods: This is a prospective, double-blinded, randomised comparative study in which 80 patients were randomly allocated into two groups-Group A in whom 20 ml of 0.5% Bupivacaine in 480 ml of normal saline was used vs Group B in whom 20 ml of 0.5% Bupivacaine plus 200 mg of Hydrocortisone in 480 ml of normal saline were instilled intraperitoneally during laparoscopic cholecystectomy and their parameters such as VAS score, shoulder pain, occurrence of post-operative vomiting, time to first rescue analgesic, total rescue analgesic requirement in 24hrs, and time to ambulation were compared.
Results: The two groups were comparable in VAS score, time to first rescue analgesic, total rescue analgesic requirement in 24hrs, and time to ambulation. The side effect profile of the two groups were also comparable with no significant difference between the groups.
Conclusions: Addition of Hydrocortisone to Bupivacaine for intraperitoneal instillation during laparoscopic cholecystectomy does not add any additional benefit in terms of duration of analgesia or time to ambulation, neither does it alter the incidence of adverse effects like vomiting or shoulder tip pain.