Comparison of Ultrasound-Guided Rectus Sheath Block Versus Local Infiltration at The Port Sites and Intraperitoneal Instillation of 0.25% Bupivacaine for Post-Operative Pain Control After Laparoscopic Cholecystectomy | ||
| International Journal of Medical Arts | ||
| Article 1, Volume 5, Issue 2, February 2023, Pages 3006-3012 PDF (1.02 M) | ||
| Document Type: Original Article | ||
| DOI: 10.21608/ijma.2023.202193.1652 | ||
| Authors | ||
| Mohamed Abdelgawad Abdelhalim Aboelsuod* 1; Ahmed Mahmoud M. M. Elgarhy1; Mohammed Shehata Zarad2; Reham Mohamed Abdelhamed Abdalla3 | ||
| 1Department of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Al-Azhar University, Cairo, Egypt | ||
| 2Department of Surgery, Faculty of Medicine [for girls], Al-Azhar University, Cairo, Egypt | ||
| 3Department of Internal Medicine, Faculty of Medicine, Tanta University, Gharbia, Egypt | ||
| Abstract | ||
| Background: Despite laparoscopic cholecystectomy being less invasive, patients report significant pain within the first 24 h following surgery. To minimize post-operative pain, a number of preoperative, intraoperative, and postoperative pain management techniques are available. These include low-pressure pneumoperitoneum, use of opioids, local anesthetic infiltration, intraperitoneal instillation, thoracic paravertebral or epidural blocks, and intraperitoneal infiltration of local anesthesia. Aim of the work: This research aimed to evaluate rectus sheath block versus local infiltration with regard to efficacy at the port sites with an intraperitoneal injection of bupivacaine for pain control following a laparoscopic cholecystectomy. Patients and Methods: This prospective comparison research involved 80 patients including both genders who were set for laparoscopic cholecystectomy. Two groups of patients were determined: Group I: Received 30 ml of 0.25 % bupivacaine 15 ml for intraperitoneal instillation and 15 ml for local infiltration at the port sites. Group R: Bupivacaine 0.25% in 30 ml was administered bilaterally [RSB] [15 ml on each side]. Results: Regarding postoperative [VAS], there was statistically significant variation among the two groups at 16 and 24 hours postoperatively [p= 0.013]. As for postoperative request analgesia, the intraperitoneal instillation group [11.8 ± 0.34 hour] and the RSB group [17.16 ±4.83 hour] as needed their first dose of rescue analgesic. Statistical analysis revealed clear group distinction [p = 0.002]. Regarding patient satisfaction. No significant variations were observed between the groups. Conclusion: Bupivacaine intraperitoneal infused with local infiltration at the port sites an effective analgesic approach, as is ultrasound-guided rectus sheath block, but [RSB] was better due to longer postoperative pain relief and less opioid consumption. Both methods are easy, risk-free, and without adverse effects. | ||
| Keywords | ||
| Rectus sheath block; Intraperitoneal instillation; Local infiltration; Bupivacaine; Laparoscopic cholecystectomy | ||
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