Infiltration of Bupivacaine In Liver Bed Versus Preperitoneal Intercostal Nerve Block In Laparoscopic Cholecystectomy

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 at the port site with its instillation into the liver bed and peritoneal cavity in reducing pain after laparoscopic cholecystectomy. Materials and Methods: This prospective randomized 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 randomized in two groups: Study group (Group A) and Control (Group B). After gallbladder was removed, patients in Group Agiven20 ml bupivacaine 0.5% in liver bed, and same amount of bupivacaine was infiltrated into 4 port sites. Group B was given a preperitoneal nerve block in addition to the insertion of bupivacaine into port sites. 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 Group A compare to Group B (p ≤ 0.05). Postoperatively no difference was observed in VAS at 24 hours between groups(p ≥ 0.05). The total doses mean of NSAID utilized in first 24 hours postoperatively were lower in Group Athan in Group B (p ≤ 0.05). Conclusion: The combination of intraperitoneal instillation and port site infiltration of bupivacaine in the liver bed following laparoscopic cholecystectomy effectively reduces pain. This straightforward, cost-effective technique should be adopted to diminish early postoperative pain in all elective cases.