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Pain control after laparoscopic cholecystectomy. A prospective study.

AIM
The purpose of this study is to evaluate three different analgesic procedures after laparoscopic cholecystectomy for pain control.


MATERIAL OF STUDY
The study involved 183 patients who underwent laparoscopic cholecystectomy with the same technique for the induction and maintenance of the general anesthesia. They were divided into three different postoperative pain treatment groups: continuous infusion of Tramadol and Ketorolac with elastomeric pump, intraperitoneal topical instillation of Levobupivacaine, and intraperitoneal aerosolization of Levobupivacaine.


RESULTS
No differences were found in the demographics. shorter operating time was observed in group 1. Eight hours after surgery in groups 2 and 3, there was an increase in pain compared to patients in the first group. The request for postoperative analgesic assistance was lower in groups 1 and 2.


DISCUSSION
Various topical and intravenous ways for analgesic actions have been used to improve the pain control after laparoscopic procedures, individually and in comparison between them. The main result of our research is that the use of levobupivacaine employed in the topical intraperitoneal application anesthesia by instillation and nebulization, do not improve the postoperative pain in the first 24 hours after LC, compared with intravenous analgesic elastomeric pump.


CONCLUSIONS
Despite the positive data found in the literature, our observations have not shown a better pain control after laparoscopic cholecystectomy with the use of intraperitoneal analgesia compared to intravenous.


KEY WORDS
Gallstone disease, Gallbladder bladder, Laparoscopic cholecystectomy, Postoperative pain, Stones.