Efficacy of Intraperitoneal 0.25% Levobupivacaine for Postoperative Analgesia Following Laparoscopic Cholecystectomy: A Prospective Randomised Double-blinded Controlled Trial
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Abstract
Laparoscopic cholecystectomy, though associated with reduced postoperative pain compared to open surgery, often necessitates effective pain management for residual visceral and referred pain. This study aimed to evaluate the efficacy of intraperitoneal instillation of 0.25% levobupivacaine in providing postoperative analgesia, focusing on time to first analgesic request and pain control compared to normal saline.
Methods: A prospective, randomised, double-blind controlled trial was conducted involving 58 adult patients undergoing elective laparoscopic cholecystectomy. Participants were randomised to receive either 30 mL of 0.25% levobupivacaine (Group A) or 30 mL of normal saline (Group B) intraperitoneally at the end of the surgery. Pain scores were assessed using the Visual Analogue Scale (VAS) in different positions at predetermined intervals. Primary and secondary outcomes were time to first analgesic request and total number of analgesic doses used in the first 24 hours, respectively. Data were analysed with SPSS software (ver. 23), and p - value < 0.05 was considered significant.
Results: The time to first analgesic request was significantly longer in Group A (Median: 240.0 mins, IQR: 153.8) compared to Group B (Median: 135.0 mins, IQR: 138.8; p = 0.025). VAS scores during coughing were significantly lower in the levobupivacaine group at 0 minutes, 15 minutes, 30 minutes, 1 hour, and 2 hours postoperatively
(p < 0.05). Total number of analgesic doses used in the first 24 hours was lower in Group A, though not statistically significant.
Conclusion: Intraperitoneal 0.25% levobupivacaine demonstrates significant efficacy in reducing postoperative pain following laparoscopic cholecystectomy, making it a valuable tool in multimodal analgesia strategies aimed at improving recovery experiences for patients undergoing this common surgical procedure.
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