Comparative Evaluation of Analgesic Outcomes of Intraperitoneal Versus Subcutaneous Administration of Bupivacaine for Laparoscopic Cholecystectomy Patients
DOI:
https://doi.org/10.37762/jgmds.13-3.893Keywords:
Laparoscopic Cholecystectomy, Pain, Analgesia, Anesthesia, OutcomesAbstract
ABSTRACT
OBJECTIVES
This study aimed to compare the analgesic efficacy and recovery outcomes of intraperitoneal versus subcutaneous administration of bupivacaine in patients undergoing laparoscopic cholecystectomy.
METHODOLOGY
This was a comparative clinical study conducted at the Department of Anesthesiology, Rawalpindi Medical University, and at Allied Hospitals. A total of 86 ASA class I patients undergoing elective laparoscopic cholecystectomy were divided into two groups: intraperitoneal bupivacaine (n=43) and subcutaneous port-site infiltration (n=43). Post-operative pain was assessed using the Visual Analog Scale (VAS) at 1, 2, 4, 6, 12, and 24 hours. Time to first rescue analgesia, total analgesic consumption, number of rescue doses, recovery parameters, and complications were recorded. Repeated measures ANOVA, independent sample t-test, and chi-square test were applied, with p ≤ 0.05 considered statistically significant.
RESULTS
Intraperitoneal bupivacaine significantly reduced post-operative VAS scores at all time intervals (p < 0.001). Repeated-measures ANOVA demonstrated significant effects of time (p < 0.001) and group (p < 0.001), indicating consistently lower pain scores in the intraperitoneal group. Time to first rescue analgesia was longer (211.1±44.1 vs 120.0±44.9 min), and total analgesic consumption was lower (82.7±24.4 vs 125.4±21.1 mg) compared with subcutaneous infiltration (p < 0.001). Patients demonstrated earlier ambulation, earlier oral intake, shorter hospital stay, and higher satisfaction (p < 0.001). Shoulder tip pain was significantly reduced (11.6% vs 46.5%), while other complications were comparable between groups.
CONCLUSION
Intraperitoneal bupivacaine was associated with improved post-operative analgesia, an enhanced recovery profile, and reduced shoulder tip pain, without increasing complications, compared with subcutaneous infiltration; however, these findings should be interpreted cautiously due to the non-randomized study design.
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