European Journal of Cardiovascular Medicine

Since the advent of laparoscopic cholecystectomy, technique has undergone a huge investigation in managing the patient post their operation. Already laparoscopic cholecystectomy has become a popular choice among the patients since the postoperative pain can be slightly controlled due to early mobilization and recovery rate. Comparatively, laparoscopic cholecystectomy is much better and full of advantages than open cholecystectomy for managing pain and decreasing the duration of hospital stay. Even though there are multiple benefits of laparoscopic cholecystectomy over the open cholecystectomy but still the postoperative pain has remained as a major issue. ¹

Parietal pain is one of the results of laparotomy and for laparoscopy there is a presence of a somatic component, a visceral component, along with a shoulder pain that is secondary to the diaphragmatic irritation which is mainly created due to CO2pneumoperitoneum ²

Several methods have been incorporated till now for decreasing the postoperative pain and they are:

• Gasless technique
• Low pressure pneumoperitoneum
• Saline washout
• Local anesthetic infiltration
• Installation of the local anesthetic agent inside the region of sub-diaphragmatic. ³, ⁴

Some previous research has proposed the use of intraperitoneal injections of the local anesthetic for minimizing the postoperative pain just after the laparoscopic surgery. One of the biggest advantages of applying local anesthetics is they do not consist of any crucial effects related to opioids.  the time required to get back to the bowel function at the time of postoperative period might also be reduced while using the opioids that is obviated through any kind of administering local anesthetics. ⁵

One of such local anaesthetics that carries a beneficial profile, that is free from side effects and acts for a longer period of time is Bupivacaine. the onset of the action while getting associated with bupivacaine hydrochloride becomes rapid and it also stays for a longer time than any other local anesthetics. The half-life of bupivacaine is 2.7 to 3.5 hours and that has been reported for providing the pain control which remains for a time period of 6 hours on an average and it decreases the need of the frequent requirement of analgesics. The upper limit of bupivacaine is 2.5 mg per kilogram of the patient's body weight. So, to carry out the safe application a patient who is lean and has a body mass of 40 kg can intake 100 mg of the drug safely and if this is used appropriately then better results are usually expected. ⁶

AIMS & OBJECTIVES

AIM:

An observational study to see the effect of 0.5% bupivacaine instillation in gall bladder fossa and trocar incision site i/v/o pain following laparoscopic cholecystectomy.

OBJECTIVES:

• To determine the analgesic efficacy of the bupivacaine in alleviating postoperative pain.
• To evaluate the pain intensity by Visual analogue scale (VAS)
• To reduce the analgesic use post operative.
• To reduce the hospital, stay post operative.

This is a Prospective Observational Study. Study includes patients admitted with acute cholecystitis going for surgery in our hospital

Period of Study: Sept 2023 to Feb 2024

Method Of Collection of Data:

All patients with known diagnosis admitted in the hospital were considered as data source. All patients were evaluated based on the detail history, clinical examination and findings, routine investigations and requiring surgical intervention.

Sample Size:  Approx 120 cases are targeted in the study and to be achieved during specified schedule of time.

Table 1: - Represent the frequency distribution of the cases according to Gender.

Table 2:-Represent the frequency distribution of the USG  Finding.

Table 3:-Represent the frequency distribution of Age category.

Table 4:-Represent the frequency distribution of vas2hr_code.

Table 5:- Association between vas2hr_code and 0-2hr Analgesic and vas2hr_code and 2-6 hr Analgesic.

(To find the Association between vas2hr_code and 0-2hr.Analgesic and the Association between vas2hr_code and 2-6hr.Analgesic, we used Chi-Square Test. Table shows the Association between vas2hr_code and 0-2hr.Analgesic, The Association were found statistically significant as the P-value is < 0.05. The Association between vas2hr_code and 2-6hr.Analgesic, The Association were found statistically not significant as the P-value is >0.05

Table 6:- Association between Vas6hr_code and 0-2hr.Analgesic.

(To find the Association between Vas6hr_code and 0-2hr.Analgesic and the Association between Vas6hr_code and 2-6hr.Analgesic, we usedChi-Square Test) Table shows the Association between Vas6hr_code and 0-2hr.Analgesic, The Association were found statistically significant as the P-value is <0.05. The Association between Vas6hr_code and 2-6hr.Analgesic. The Association were found statistically significant as the P-value is <0.05.

Statistical analysis has been performed by using the SPSS version of 20. For calculating the mean and standard deviation the quantitative data was being used where is for calculating percentage and frequency the uses of qualitative data has been used. In order to find the correlation within the categorical variables, chi square test has been performed and for comparing the mean values we have applied the one-way ANOVA test where the level of significance is being taken as 5% or < 0.005. 120 study subjects have been considered for this study.

The result started with the frequency distribution of the cases as per the gender which showed that the number of females outnumbers the number of males and the values were 70% and 30 % respectively. Similar to our study, researchers Kranke et al. did notice that in their study also the numbers of females were more than the number of males and it was 63% and 37% respectively.⁷

1. While identifying the frequency distribution of USG findings, the maximum percentage of the subjects were found to be in the category of “M” that was 44.1 %. But in the study of Franck et al. contrastingly the maximum of the study subjects was seen to be under the USG finding of “s” that accounted for 55%. ⁸
2. The Representation of the 2hr.Predominant Site Of Pain (RHC/Trocar) that was categorized under four types show that most of the study subjects were under the category of no instead of RHC or Trocar and accounted for 75%. For the 6hr. In the study of Verma et al. the frequency of the pain shows that maximum of the patients experienced visceral pain which accounted for 78.33 % ⁹
3. the association between the VAS2hr_code along with the 0-2hr Analgesic was being calculated which contrastingly showed the P value to be statistically significant as it was 0.017 which was < 0.05, but the association between VAS2hr_code along with the 2-6hr Analgesic, the Representation of the association between VAS6hr_code along with the 0-2hr Analgesic, VAS2-6hr_code along with the 2-6hr Analgesic and Analgesic resulted along with the p-value of 0.007, that was identified to be significant statistically since the p – value was <0.05. Similarly, the results of the Patel et al. Show that our association between the hourly categories along with the age was not significant at all. ¹⁰

This study concluded that after laparoscopic cholecystectomy the visceral pain becomes prominent and for evaluating the effect of the total pain score over different times along with the intensity of different types of pain, this study was carried out. The efficacy of bupivacaine was observed at time duration gaps of 2 hours, 6 hours to show that it was really effective. Maximum of the patients did not experience the pain while the intensity was being measured by using the visual analogue scale. The duration of the postoperative hospital stays also got reduced to a great extent. Finally, it can be concluded that indeed the installation of 0.5% Bupivacaine in the gallbladder effectively controls the intensity of pain

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