Scholarly Article
Effect of Intraperitoneal Bupivacaine Irrigation on Postoperative Pain Following Laparoscopic Cholecystectomy: A Randomised Controlled Trial
Muzammil, Manal, Kiran, Almas, Khan Tanoli, Zulfiqar, Rahman, Anamta, Mustafa, Umar, Nihal hashmi, Tajwar
2025-07-31 · Impact Surgery · Impact Health Publishing Group
Abstract
Background: Postoperative pain remains a significant challenge after laparoscopic cholecystectomy, particularly in resource-limited settings. Local anaesthetic instillation into the liver bed has been proposed as a simple technique to reduce visceral pain and facilitate early recovery. The objective of this study was to evaluate the effectiveness of 0.5% bupivacaine irrigation into the gallbladder bed in reducing postoperative pain severity following laparoscopic cholecystectomy. Methods: This was a two-arm, double-blind, prospective randomised controlled trial conducted at the Federal Government Polyclinic Hospital, Islamabad, from March to September 2020. Sixty-two patients aged 18-65 years undergoing elective laparoscopic cholecystectomy were randomised equally into intervention (bupivacaine irrigation) and control (standard care without local anaesthetic irrigation) groups. Randomisation used folded paper allocation and was performed by surgical residents; outcome assessors and patients were blinded. The primary outcome was the proportion of patients reporting severe pain at 24 hours postoperatively using a 10-point visual analogue scale (VAS). Secondary outcomes included pain severity stratified by age and gender. Results: At 24 hours, none of the patients in the bupivacaine group reported severe pain, compared with five (16.1%) in the control group (p = 0.036). Younger patients (≤30 years) in the intervention group had significantly lower pain scores compared to controls (p<0.001). No significant differences were observed by gender. No adverse events were reported. Conclusions: Irrigation with 10 ml of 0.5% bupivacaine into the liver bed during laparoscopic cholecystectomy significantly reduced the severity of postoperative pain at 24 hours. This simple intervention may enhance recovery and facilitate early discharge, especially in low-resource settings. Further multicentre trials are recommended to inform standardised postoperative analgesia protocols.
Keywords
cholecystectomy, gallstone disease, anaesthetics
Citation Details
Impact Surgery, No. 11, pp. 166-173