Ideal Local Anesthetic for Intraperitoneal Gallbladder Bed Infiltration Following Laparoscopic Cholecystectomy: A Randomized Controlled Trial.

Background Laparoscopic cholecystectomy is the gold standard operation for symptomatic cholelithiasis; however, pain remains a major factor in increasing morbidity and length of hospital stay. Infiltration of the gallbladder bed with a local anesthetic has been shown to improve postoperative pain after laparoscopic cholecystectomy, although it is unclear which local anesthetic provides superior pain relief. Objective The aim of this study was to compare the efficacy of various local anesthetics on postoperative pain when instilled intraperitoneally in the gallbladder bed following laparoscopic cholecystectomy. Methods Patients undergoing laparoscopic cholecystectomies were randomized into three groups of 30 patients each, depending on the local anesthetic instilled in the gallbladder bed: lignocaine (Group A), bupivacaine (Group B), or a combination of lignocaine and bupivacaine (Group C). Pain was measured using the Visual Analogue Scale (VAS) at two, six, 12, and 24 hours following surgery. Secondary outcomes included vitals, rescue analgesic use, return of bowel function, time to ambulation, and presence of nausea. Results Group C showed the lowest pain scores at all time points compared to the other groups (p < 0.05). Mean arterial pressures and heart rates were lower in Group C than in Group A at two and 24 hours. Return of bowel function and time to ambulation was earlier in Group C than in Group B. No significant complications were noted in any of the groups. Conclusion We conclude that a combination of lignocaine and bupivacaine instillation in the gallbladder bed provides the most effective pain relief following laparoscopic cholecystectomy, without significant complications at the doses used.