Intrapleural bupivacaine for postoperative analgesia after cholecystectomy.

Thesis Report.

ABSTRACT: The purposes of this randomized double blind placebo study was to find out duration of analgesia and postoperative opioid sparing and analgesic effect of single dose 20 ml of 0.5% intrapleural bupivacaine in patients of ASA I and ASA ii undergoing elective cholecystectomy. 40patients were randomly allocated in to two groups. Two patients were excluded from the study. Twenty patients received 20ml of 0.5% bupivacaine Group -A and 18 patient received 20 ml of normal saline Group-B, intrapleural injection done at 6th intercostals space in midaxillary line at the end of surgery before extubation. Duration of analgesia was more in the Group-A , 107.65+_7.58 minutes. (mean+_SD) with maximum of 4 hours 10 minutes , in the Group=B, it was 26.11+_ 7.58 minutes. The amount of pethidine and promethazine reqi=uired in 24 hours was significantly more in the group-B, mean_+SD 175.00+_25.73 mg and 87.7+_12.86 mg than in Group-A , 90.00+_26.16mg and 45.00_+13.08 mg respectively (pvalue 0.000) with reduction of analgesic requirement in the Group-A by 48.57%. Pain was assessed by visual analogue scale (VAS), when pain was first perceived, after 4 hours and after 8 hours of intrapleural administration, at rest (VASR) after allowing to cough (VASC) and pressing over the operated wound (VASP). There was significant decrease in the level of pain in the Group-A, VASR reduced by 24.57%, 30.83% and 6.99%, VASC was reduced by 32.11% , 25.42% and 7.47%; VASP was reduced by 24.57%,21.70% and 10.02% in comparison with Group-B. No central nervous system toxicity, pneumothorax and other complications were noted. It was concluded that 20ml of 0.5% intrapleural bupivacaine can be safely and effectively used for postoperative analgesia after cholecystectomy. Key Words: Analgesthetic technique: intrapleural single dose no catheter technique ,Anesthetics: Local- bupivacaine, Pain: postoperative

Eng.