Comparison of Standard Analgesia versus Intra-Operative Local Anesthesia in Postoperative Pain Management Among Patients Undergoing Laparoscopic Cholecystectomy

Sajjad Ahmad Ansari; Muhammad Aqib Riaz; Sonia Khan; Afzal Saeed  Awan; Faizan  Muhammad; Shaila  Riaz

doi:10.51253/pafmj.v75iSUPPL-2.10863

Authors

Sajjad Ahmad Ansari Department of Surgery, Combined Military Hospital Multan/National University of Medical Sciences (NUMS) Pakistan
Muhammad Aqib Riaz Department of Surgery, Combined Military Hospital Multan/National University of Medical Sciences (NUMS) Pakistan
Sonia Khan Sir Ganga Ram hospital Lahore
Afzal Saeed Awan Department of Surgery, Combined Military Hospital Multan/National University of Medical Sciences (NUMS) Pakistan
Faizan Muhammad Department of Surgery, Recep tayyip erdogan hospital muzaffargarh Pakistan
Shaila Riaz Tehsil Headquarter Hospital, Kot Adu Pakistan

DOI:

https://doi.org/10.51253/pafmj.v75iSUPPL-2.10863

Keywords:

Cholelithiasis, Laparoscopic Cholecystectomy, Postoperative Pain

Abstract

Objective: To compare standard analgesia alone versus addition of intra-operative local anesthesia in postoperative pain management among patients undergoing laparoscopic cholecystectomy.

Study Design: Quasi experimental study.

Place and Duration of Study: Combined Military Hospital, Multan Pakistan, from Jul 2022 to Apr 2023.

Methodology: Eighty (n=80) patients were divided in two equal groups by draws method (Group A and B). Group A was managed by standard analgesia plus intra–operative local anesthesia while group B was managed by only standard analgesia. Post-operative pain assessment was done using visual analogue scale after every hour for 24hours. SPSS version 23 was used to analyze the data. Mean pain score in both groups was compared by applying independent sample t-test at 0.05 level of significance.

Results; A total of eight variables were compared in the two groups. Variables like age (p=0.333), gender (p=0.817), residential status (p=0.464), socioeconomic status (p=0.803) and associated comorbid like diabetes Mellitus (p=0.554), hypertension (p=0.488) and obesity (p=0.791) were comparable in both the groups. However, Median Pain Score (visual analogue scale) was significantly lower (p=0.001) in group A compared to group B.

Conclusion; Addition of local anesthesia in group A patients resulted in less postoperative pain as compared to group B patients receiving standard analgesia only. Hence all clinicians treating such patients should employ intra–operative local anesthesia for better postoperative pain management.

Downloads

References

Rutherford D, Massie EM, Worsley C, Wilson MS. Intraperitoneal local anaesthetic instillation versus no intraperitoneal local anaesthetic instillation for laparoscopic cholecystectomy. Cochrane Database Syst Rev 2021; 10(10): CD007337. https://doi.org/10.1002/14651858.CD007337.pub4

Wang F, Peng P, Zheng Y, Cheng S, Chen Y. Effect of Acupuncture on Postoperative Pain in Patients after Laparoscopic Cholecystectomy: A Randomized Clinical Trial. Evid Based Complement Alternat Med 2023: 3697223.

https://doi.org/10.1155/2023/3697223

Stinton LM, Shaffer EA. Epidemiology of gallbladder disease: cholelithiasis and cancer. Gut Liver 2012;6(2): 172-187.

https://doi.org/10.5009/gnl.2012.6.2.172

Nasir A, Zulfiqar T, Ali A, Zafar H. Prevalence of Gallstone Disease and its Correlation with Age among People Undergoing Abdominal Ultrasound in Gujranwala. EAS J Radiol Imaging Technol Vol-3, Iss-3 2021: 142-145.

https://doi.org/10.36349/easjrit. 2021.v03i03.004

Ahmed W, Haq ZU, Ahmed I. Pattern of Hospital Admissions in Surgical Ward. Isra Med J 2017; 9(3): 135-140.

Amin A, Haider MI, Aamir IS, Khan MS, Khalid Choudry U, Amir M, Sadiq A. Preoperative and Operative Risk Factors for Conversion of Laparoscopic Cholecystectomy to Open Cholecystectomy in Pakistan. Cureus 2019; 11(8): e5446.

https://doi.org/10.7759/cureus.5446

Waleed MS, Khawaja UA, Akhtar M, Sadiq W. Laparoscopic Cholecystectomy: An Early Experience at A Tertiary Care Hospital in Islamabad. J Comm Med Pub Health Rep 2020; 1(4).

https://doi.org/10.40207/JCMPHR

Bakan M, Umutoglu T, Topuz U, Uysal H, Bayram M, Kadioglu H, et al. Opioid-free total intravenous anesthesia with propofol, dexmedetomidine and lidocaine infusions for laparoscopic cholecystectomy: a prospective, randomized, double-blinded study. Braz J Anesthesiol 2015; 65(3): 191-199.

https://doi.org/10.1016/j.bjane.2014.05.001

Cianci P, Tartaglia N, Fersini A. Pain control after laparoscopic cholecystectomy. A prospective study. Ann Ital Chir 2020; 91: 611-616.

Toolabi K, Elyasinia F, Taftian E, Sadeghian E, Soroush AR. The Comparison of Postoperative Pain, Nausea, and Vomiting between Veress Needle Entry and Direct Trocar Entry Methods in Patients Undergoing Laparoscopic Cholecystectomy. Middle East J Dig Dis 2021; 13(1): 54-60.

https://doi.org/10.34172/mejdd.2021.204

Abdelaziz DH, Boraii S, Cheema E, Elnaem MH, Omar T, Abdelraouf A, et al. The intraperitoneal ondansetron for postoperative pain management following laparoscopic cholecystectomy: A proof-of-concept, double-blind, placebo-controlled trial. Biomed Pharmacother. 2021 Aug;140 :111725. https://doi.org/10.1016/j.biopha.2021.111725

Protic M, Veljkovic R, Bilchik AJ, Popovic A, Kresoja M, Nissan A, et al. Prospective randomized controlled trial comparing standard analgesia with combined intra-operative cystic plate and port-site local anesthesia for post-operative pain management in elective laparoscopic cholecystectomy. Surg Endosc 2017; 31(2): 704-713.

https://doi.org/10.1007/s00464-016-5024-5

Surender, Arora P, Khurana G, Sachan PK. Comparison of Postoperative Quality of Recovery and Pain Relief with Preoperative Single-Dose Dexamethasone and Lignocaine after Laparoscopic Cholecystectomy. Anesth Essays Res 2018; 12(3): 630-635.

https://doi.org/10.4103/aer.AER_82_18

Sharma B, Garg R, Sahai C, Gupta AK, Gera A, Sood J. Effect of perioperative lignocaine infusion on postoperative pain relief for laparoscopic intraperitoneal onlay mesh repair: A randomized controlled study. Asian J Endosc Surg 2022; 15(4): 805-773.

https://doi.org/10.1111/ases.13089