Comparison of intra-peritoneal bupivacaine and intravenous paracetamol for postoperative pain relief after laparoscopic cholecystectomy

BACKGROUND: Nonsteroidal anti-inflammatory drugs used for postoperative analgesia have considerable adverse effects, with paracetamol having a different mechanism of action, superior side effect profile and availability in intravenous (IV) form, this study was conducted to compare intra-peritoneal bupivacaine with IV paracetamol for postoperative analgesia following laparoscopic cholecystectomy. AIM: The aim was to compare the efficacy of intra-peritoneal administration of bupivacaine 0.5% and IV acetaminophen for postoperative analgesia in patients undergoing laparoscopic cholecystectomy. SETTINGS AND DESIGN: Randomized, prospective trial. MATERIALS AND METHODS: A total of 60 patients of American Society of Anesthesiologists physical Status I and II scheduled for laparoscopic cholecystectomy were enrolled for this study. Group I received 2 mg/kg of 0.5% bupivacaine as local intra-peritoneal application and Group II patients received IV 1 g paracetamol 6(th) hourly. Postoperatively, the patients were assessed for pain utilizing Visual Analog Scale (VAS), Visual Rating Prince Henry Scale (VRS), shoulder pain. The total number of patients requiring rescue analgesia and any side-effects were noted. STATISTICAL ANALYSIS: Data analysis was performed using Students unpaired t-test. SPSS version 11.5 was used. RESULTS: The VAS was significantly higher in Group I compared with Group II at 8(th), 12(th) and 24(th) postoperative hour. At 1(st) and 4(th) postoperative hours, VAS was comparable between the two groups. Although the VRS was higher in Group I compared with Group II at 12(th) and 24(th) postoperative hour; the difference was statistically significant only at 24(th) postoperative hour. None of the patients in either of the groups had shoulder pain up to 8 h postoperative. The total number of patients requiring analgesics was higher in Group II than Group I at 1(st) postoperative hour. CONCLUSION: Although local anesthetic infiltration and intra-peritoneal administration of 0.5% bupivacaine decreases the severity of incisional, visceral and shoulder pain in the early postoperative period, IV paracetamol provides sustained pain relief for 24 postoperative hours after elective laparoscopic cholecystectomy.