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

Background: Present study was undertaken to assess duration and quality of post-operative analgesia in patients undergoing laparoscopic cholecystectomy receiving parentral opioids or local intaperitoneal instillation and port-site infiltration with bupivacaine hydrochloride (HCL) or intercostal nerve block with bupivacaine HCL.

Materials and methods: 100 Americian Society of Anaesthesiologist( ASA) grade I and II patients of either sex between the age group 20-60 years 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 intercostals nerve block with 0.25 % bupivacaine (posterior approach, T₅-T₁₁), group III (iv BUT) received intravenous (i.v) butorphanol 20 mg kg^-1 and group IV (CONT) received analgesia with injection diclofenac sodium 75 mg intramuscular (i.m) as and when needed at the end of surgery. Post operatively following parameters were observed for 24 hours and analysed statistically :Pain using Visual Analogue Scale(VAS),shoulder pain, duration of analgesia, hemodynamic variables, sedation score, rescue analgesic and  side effects.

Results: We found that intercostal nerve block produced effective analgesia of longer duration (9.48 + 4.44 hrs) with almost negligible side effects, whereas i.v butorphanol produced excellent analgesia but of shorter duration (5.04 + 1.73 hrs), with slightly more incidence of nausea and vomiting. Intraperitoneal instillation and port site infiltration with bupivacaine provided comparable analgesia (6.54 + 4.63 hrs) with no major side effects.

Conclusion: Intercostal nerve block is a safer and effective analgesia technique of longer duration with almost neglible side effects.

DOI: http://dx.doi.org/10.4038/slja.v21i1.4082