Comparison of Pain and Requirement of Injectable Anti-Inflammatory Drugs with and without Port Site Infiltration of Injection Bupivacaine in Laparoscopic surgeries

Abstract

Background: Laparoscopic surgery is associated with shorter hospital stay, less post-operative pain and excellent cosmesis. Post-operative pain is lesser in laparoscopic procedures but in some cases, it is not absolutely painless. The aim of different methods to reduce the post-operative pain is to avoid the use of opioids by using anti-inflammatory drugs and infiltration of local anesthesia either intra-peritoneal or in the wound. Theoretically peripheral blockage of pain stimuli with local anesthetic agent is more effective than treating pain. For this purpose, Bupivacaine has been recently used to be injected at port sites. Objective: To evaluate the pain and requirement of injectable anti-inflammatory drug (inj. Ketorolac 30mg) after port site infiltration of inj. bupivacaine in laparoscopic cases. Study Design: Prospective randomized study of elective laparoscopic procedures. Settings: Surgical Unit-IV, DHQ Teaching Hospital Faisalabad, Medical University Faisalabad Pakistan. Duration: November 2015 to May 2017. Methodology: Two hundred and sixty patients included in the study were divided into two groups with equal number in each group. Results: In the study group(A), 103(79.3%) patients were females of 27(20.7%) patients were males. All female patients in the study group underwent LC and among males, 26(96.3%) patients underwent TAPP and 1(3.7%) patient underwent LC. In the control group(B) 97(74.6%) patients were females, 33(25.4%) patients were male. All female patients (100%) underwent LC and among the males, 30 patients (90.9%) underwent TAPP, 3(9.1%) patients underwent LC. In the study group, the mean VAS in the study group at 2 hours, 6 hours, 12 hours after surgery was 1.6, 1.7, 1.6 with standard deviation 1.6, 1.7, 1.8 respectively while in the control group VAS was 2.9, 3.1, 2.6 with standard deviation 2.1, 1.8, 1.9 respectively. In the study group the mean of anti-inflammatory drug injections (Ketorolac) needed was 1.0000 with standard deviation 0.7 and in control group, the same was 1.3 with standard deviation 70.8. The previous was less than 0.05. Conclusion: Infiltration of local anesthetic agent i.e., Bupivacaine results in almost total painless procedure in laparoscopic surgery, the timing and anatomical site of injection should be investigated further.