A Study of Intraperitoneal Instillation of Levobupivacaine in Gall Bladder Fossa for Assessment of Postoperative Pain after Laparoscopic Cholecystectomy

Background: Even though laparoscopic cholecystectomy is associated with less discomfort following surgery, many patients still report mild shoulder and stomach pain in the first 48 hours. This prospective, controlled study aims to assess the impact of intraperitoneal levobupivacaine instillation on postoperative pain reduction following laparoscopic cholecystectomy. Methods: Patients undergoing laparoscopic cholecystectomy for symptomatic gallstones are the subjects of this prospective controlled study. Patients are randomly assigned to one of two groups: group A will not receive any intraperitoneal instillation following the procedure, and group B will receive intraperitoneal instillation of levobupivacaine (0.25%, 20ml) following the procedure. The amount of NSAIDs administered and the assessment of postoperative pain were documented at predetermined intervals in accordance with the VAS. Shoulder tip discomfort and nausea/vomiting were also assessed along with the duration of the hospital stay. Results: Mean pain scores up to 6 hours after surgery were lower in group B than in group A. The difference was statistically significant (p < 0.05). There was a substantial incidence of shoulder tip discomfort. However, pain levels at 6 hours were not substantially different between the two groups. Group A had substantially greater mean total NSAID consumption (p=<0.05) and a shorter initial dose of rescue analgesia than group B. Group B had a considerably shorter mean hospital stay than Group A (P < 0.05). We had no negative effects from administering levobupivacaine intraperitoneally. Conclusion: To conclude, levobupivacaine is effective in preventing pain up to the first 6hours after laparoscopic cholecystectomy when instilled intraperitoneally at the end of laparoscopic cholecystectomy. Levobupivacaine is better choice because of its higher efficacy and larger safety margin. This modality of treatment is cost effective in terms of patient care in post operative units, lesser NSAID and opioid requirement and helps the patient to get a better post operative recovery and early discharge.