Background: Laparoscopic Cholecystectomy [LC] has become the gold standard for treatment of benign gall bladder disease. Pain after laparoscopic cholecystectomy though primarily visceral, often affecting sub diaphragmatic region and often referred to the right shoulder region, also has a parietal component which occurs at the trocar site.
Aim: This study was conducted to compare postoperative pain control with use of 0.5% bupivacaine- soaked sheet of regenerated oxidized cellulose in the gallbladder bed versus port site infiltration of 0.5% bupivacaine after laparoscopic cholecystectomy.
Material and Method: Total patients were 75, which were divided in three groups - Group A (n=25) bupivacaine- soaked sheet of regenerated oxidized cellulose was placed in the gall bladder bed, Group B (n=25) bupivacaine was infiltrated at trocar site before skin suturing, Group C (n=25) was the control group. Nature of pain - visceral, parietal or shoulder was assessed on VAS at 3,6 & 24hrs after surgery.
Results: All patients demonstrated different intensities of visceral and parietal pain in all groups. No patient had shoulder pain. Visceral pain at 3, 6 & 24hr was significantly less in group A (2.04±1.71, 1.56±1.68 & 0.40±0.57) as compare to group B (3.08±0.70, 2.56±1.29 &1.28±0.54) & group C (4.32±0.62, 3.84±0.85 & 3.08±0.91) (p< 0.05). Parietal pain at 3,6 & 24hrs for group B (2.28±1.45, 1.36±1.22& 0.60±0.50) was less than group A (2.76±0.66, 2.28±0.54 & 1.12±0.44) & group C (4.64±0.86, 3.68±0.90 &3.16±0.80) (p<0.05). Postoperative analgesic requirement was 16% in Group A, 20% in Group B and 100% in Group C.
Conclusion: Bupivacaine (0.5%) soaked sheet of regenerated oxidized cellulose (ROC) in the gall bladder bed is safe, increases postoperative comfort and decreases postoperative analgesics requirement after laparoscopic cholecystectomy as compare to trocar site infiltration.