Randomized Control Trial of Intraperitoneal Bupivacaine During Cholecystectomy
Randomized Control Trial of Intraperitoneal Bupivacaine During Cholecystectomy
Laparoscopic cholecystectomy (removal of the gall bladder via 'keyhole surgery') is a common
 procedure. This can be performed as an emergency operation when a patient has a complication
 of gall stones such as acute inflammation or pancreatitis. There are several trials which
 demonstrate that placing local anaesthetic inside the abdomen at the site of gall bladder
 surgery during a planned elective operation decreases post operative pain. This is the first
 trial to investigate the efficacy of this local anaesthetic during emergency cholecystectomy.
Background Several studies, including a metanalysis, have demonstrated that intraperitoneal
 local anaesthetic (IP LA) during elective laparoscopic cholecystectomy (el-LC) decreases post
 operative pain. None have explored the efficacy of IP LA at emergency laparoscopic
 cholecystectomy (em-LC). A longer operation duration, greater frequency of washing and the
 inflammation associated with cholecystitis or pancreatitis are a few reasons why it cannot be
 assumed that a benefit in pain scores will be seen in em-LC with IP LA. This study assesses
 the efficacy of IP LA used in patients undergoing em-LC.

 Methods Double blind randomised sham controlled trial of 42 consecutive subjects undergoing
 em- LC.

 IP-LA was delivered by a combination of direct injection to the diaphragmatic and topical
 wash over the liver/gall bladder with bupivacaine or sham depending upon allocation. The
 primary outcome was VAS pain scores on the ward. Secondary outcomes included VRS pain scores
 in theatre recovery, analgesic use, physiological observations, time to eating and ambulation
 and length of postoperative stay.

 Results One patient had a procedure converted to open and was excluded. There was no
 significant difference in pain scores on the ward or in theatre recovery. Analgesic use,
 respiratory rate, oxygen saturation, duration to ambulation, eating, satisfaction scores and
 time to discharge were comparable between the groups.

 Conclusions Intraperitoneal LA during em-LC does not influence post-operative pain. Other
 modalities of analgesia should be explored as well as decreasing the interval between
 diagnosis of acute admission and em-LC.
Inclusion Criteria:

 -  patients undergoing emergency cholecystectomy for cholecystitis or gall stone
 pancreatitis

 Exclusion Criteria:

 -  patients undergoing planned elective cholecystectomy