RCT: Multi-modal Analgesia for Laparoscopic Cholecystectomy
RCT: Multi-modal Analgesia for Laparoscopic Cholecystectomy
Analgesic efficacy of multi-modal analgesia is superior to standard analgesia for patients
 undergoing elective laparoscopic cholecystectomy for symptomatic cholelithiasis. Topical
 cystic plate and port-site incision 0.25% bupivacaine significantly reduces pain after
 laparoscopic cholecystectomy.
Background: Peri-portal nerve stimulation has recently been suggested as a mechanism for pain
 after laparoscopic cholecystectomy (LapChole). We therefore conducted a PRCT to evaluate
 whether somatovisceral pain blockade reduces pain after LapChole.

 Hypothesis:Analgesic efficacy of multi-modal analgesia is superior to standard analgesia for
 patients undergoing elective LapChole for symptomatic cholelithiasis. Specifically, topical
 cystic plate and port-site infiltrationwith0.25% bupivacaine significantly reduces pain after
 LapChole.

 Design: Single-blinded PRCT Setting: Academic medical centers Patients and Methods: Between
 February and May 2010 we randomly assigned 63 patients with symptomatic cholelithiasis in a
 1:1 ratio to institutional standard non-opioid/opioid analgesic combinations (n=32), and
 institutional standard analgesia plus topical 0.25%bupivacaine spray onto the cystic plate
 and local 0.25% bupivacaine port-site injection,post-LapChole (n=31). Primary endpoint was
 patient-reported pain 1, 4, 6, 12, and 24 hours, and 1 week post-LapCholeusing the Visual
 Acuity Score (VAS, 0-10).

 Results: Study groups were comparable clinicopathologically. There were no
 study-procedure-associated adverse events. A statistically significant reduction in mean pain
 score was apparent in patients receiving multi-modal analgesia at all early (1-6 hours)
 post-operative time points and at one week following LapChole(p<0.05).

 Conclusion: This PRCT shows significantly improved pain reduction with somatovisceral pain
 blockade than institutional standard analgesic combinations following LapChole for
 symptomatic cholelithiasis. For centers not utilizing adjunctive local anesthetic for this
 operation, this multi-modal analgesic approach can improve patient comfort during
 recovery.This approach serves as the basis for a planned 4-arm PRCT designed to provide
 further insights into the role of local anesthetics in multi-modal operative site analgesia.
Inclusion Criteria:

 -  symptomatic cholelithiasis undergo elective laparoscopic cholecystectomy

 -  non - pregnant women

 -  18 years or older

 Exclusion Criteria:

 -  undergoing urgent cholecystectomy

 -  patients operated on for indications other than symptomatic cholelithiasisT

 -  those having conversion from laparoscopic to open cholecystectomy

 -  those that withdrew from the study for any reason before the end of the required 7-day
 follow up (including those that died during that period)

 -  those with incomplete data.