Comparative evaluation of post-operative analgesic effects of intraperitoneal levobupivacaine plus fentanyl and levobupivacaine plus tramadol in patients undergoing laparoscopic cholecystectomy
Abstract
Background: Laparoscopic cholecystectomy is commonly performed as a day care procedure for treating symptomatic gallstones. Suitability of patient discharge from the inpatient facility depends upon adequacy of postoperative pain control. Among the various modalities for pain relief, intraperitoneal local anaesthetic has become an important approach. In this study we aimed at comparing the post-operative analgesic effects of intraperitoneal levobupivacaine plus fentanyl and levobupivacaine plus tramadol in patients after laparoscopic cholecystectomy. The objective of this study was to determine which adjuvant drug was superior to the other in terms of prolonging the analgesic effects of levobupivacaine in post-operative period of laparoscopic cholecystectomy.
Methods: A total of 90 patients undergoing laparoscopic cholecystectomy were selected. They were divided into three groups: Group L- received 50 ml of 0.25% levobupivacaine; Group LT- received 0.25% of levobupivacaine and tramadol 2 ml (50 ml total); group LF- received 0.25% levobupivacaine plus fentanyl 2 ml (50 ml total). Postoperative pain was assessed using visual analogue scale.
Results: The combination of levobupivacaine fentanyl and levobupivacaine tramadol was superior to plain levobupivacaine for reducing postoperative pain. No significant difference was found between Group LT and LF with respect to first analgesic and total analgesic requirement. However significant difference was found between LF and L; and between LT and L.
Conclusions: Levobupivacaine should be used along with adjuncts either tramadol or fentanyl.
Keywords
Full Text:
PDFReferences
Carr DB, Goudas LC. Acute pain. Lancet. 1999;20:51-8.
Atkinson R, Rushman G, Lee J. A synopsis of Anaesthesia Bristol Wright 1987;10:637-40.
Joris J, Thiry E, Paris P, Weerts J, Lamy M. Pain after laparoscopic cholecystectomy: characteristics and effect of intraperitoneal bupivacaine. Anaesth Analg. 1995;81:379-84.
Thierry L, Xavier MJ, Xavier P, Dominique F, Dan B. The clinical efficacy and pharmacokinetics of intraperitoneal ropivacaine for laparoscopic cholecystectomy. Anesthesia Analgesia. 2002;94:100-5.
Jiranantarat V, Rushatamukayanunt W, Lert- akyamanee N, et al. Analgesic effect of intraperitoneal instillation of bupivacaine for postoperative laparoscopic cholecystectomy. J Med Assoc Thai. 2002;85:897-903.
Golubovic S, Golubovic V, Cindric- Stancin M, Tokmadzic V. Intraperitoneal analgesia for laparoscopic cholecystectomy: bupivacaine versus bupivacaine with tramadol. Coll Antropol. 2009;33:299-302.
Pappas-Gogos G, Tsimogiannis KE, Zikos N, Nikas K, Manataki A, Tsimoyiannis EC. Preincisional and intraperitoneal ropivacaine plus normal saline infusion for postoperative relief after laparoscopic cholecystectomy: a randomized doubleblind controlled trial. Surg Endosc. 2008;2:2036-45.
Tobias JD. Pain, management following laparoscopy: Can we do better? Saudi J Anaesth. 2013;7:3-4.
Liu SS, Hodgson PS. Local anaesthetics. In: Barash PG, Cullen BF, Stoelting RK (eds). Clinical Anaesthesia. 4th edition. Philadelphia: Lippicott Williams and Wilkins; 2001: 449-69.
Gupta R, Bogra J, Kothari N, Kohli M. Postoperative analgesia with intraperitoneal fentanyl and bupivacaine: a randomized control trial. Canadian J Med. 2010;1:1-11.
Singh A, Mathur SK, Shukla VK. Postoperative analgesia with intraperitoneal ropivacaine with and without fentanyl after laparoscopic cholecystectomy: A randomized double-blind controlled trial. OA Anaesthetics. 2013;1:1-9.
Goldstein A, Grimault P, Henique A, Keller M, Fortin A, Darai E. Preventing postoperative pain by local anaesthetic instillation after laparoscopic gynaecologic surgery: a placebo-controlled comparison of bupivacaine and ropivacaine. Anaesth Analg. 2000;91:403-7.
Memis D, Turan A, Karamanlioglu B, Tukenmez B, Pamukcu Z. The effect of tramadol or clonidine added to intraperitoneal bupivacaineon postoperative pain in total abdominal hysterectomy. J Opioid Manag. 2005;1:77-82.
Rademaker BM, Kalkman CJ, Odoom JA, de Wit L, Ringers J. Intraperitoneal local anaesthetics after laparoscopic cholecystectomy: effects on postoperative pain, metabolic responses and lung finction. British J Anaesth. 1994;72:263-6.
Ali PB, Cotton BR, Williamson KM, Smith G. Intraperitoneal bupivacaine or lidocaine does not provide analgesia after total abdominal hysterectomy. Br J Anaesth. 1998;80:245-7.
Bhardwaj N, Chari P, Sharma V. Intraperitoneal bupivacaine on pain after laparoscopic cholecystectomy. Indian J Anaesth. 2002;46:49-52.
Kim TH, Kang H, Park JS, Chang IT, Park SG. Intraperitoneal ropivacaine instillation for post-operative pain relief after laparoscopic cholecystectomy. J Korean Surg Soc. 2010;79:130-6.
Email this article