Post-operative analgesic technique in laparoscopic cholecystectomy: Comparison of local instillation with bupivacaine vs intravenous butorphanol vs intercostal nerve block with bupivacaine

Abstract

Background Present study was undertaken to evaluate an optimal analgesic technique which is safe, effective, feasible and devoid of side effects and complication for post-operative analgesia in patients undergoing laparoscopic cholecystectomy. The techniques under study were parenteral opioids or local intraperitoneal instillation and port-site infiltration with bupivacaine hydrochloride (HCL) or intercostal nerve block with bupivacaine HCl. Materials and methods The study was a prospective, double blind, randomized controlled trial. 100 American Society of Anaesthesiologists (ASA) grade I and II patients of either sex between the age group 20-60yrs undergoing laparoscopic cholecystectomy under general anaesthesia (GA) were randomly allocated into IV groups of 25each.Group I (IP) received intraperitoneal instillation with 15 ml of 0.375% bupivacaine and port site infiltration with 10 ml of 0.25% bupivacaine, group II (ICNB) received bilateral intercostal nerve block with 0.25% bupivacaine (posterior approach, T5-T11), group III (iv BUT) received intravenous butorphanol 20 μg kg-1 and group IV (CONT) received analgesia with injection diclofenac sodium 75 mg intramuscular when Visual Analogue Scale (VAS) was ≥ 6 at the end of surgery. Post operatively pain using visual analogue scale (VAS), shoulder pain, duration of analgesia, haemodynamic variables, sedation score, rescue analgesic and side effects were observed for 24 hours and analysed statistically. Results We found that intercostal nerve block produced effective analgesia of longer duration (9.48 ± 4.44hrs) with almost negligible side effects, whereas i.v. butorphanol produced excellent analgesia but of shorter duration (5.04 ± 1.73hrs), with slightly more incidence of nausea and vomiting. Intraperitoneal instillation and port site infiltration with bupivacaine provided comparable analgesia (6.54 ± 4.63hrs) with no major side effects. Conclusion Intercostal nerve block is a safe and effective analgesia technique of longer duration with almost negligible side effects.