Işık ALPER, Sezgin ULUKAYA, Meltem UYAR, Gülsüm YÜKSEL, Taner BALCIOĞLU

Laparoscopic cholecystectomy pain: effects of the combination of incisional and intraperitoneal levobupivacaine before or after surgery

Amaç: İnsizyonel ve intraperitoneal %0.25 levobupivakain kombinasyonunun uygulama zamanının laparoskopik kolesistektomi sonrası ağrı üzerine etkisinin ileriye yönelik, randomize, kontrollü çalışma olarak araştırılması amaçlandı. Gereç ve Yöntem: Altmış altı hasta üç gruptan birine dahil edildi. Grup BS ye, trokar yerlerine insizyon yapılmadan önce ve pnömo- peritonyumdan hemen sonra levobupivakain uygulandı. Grup AS ye trokarlar çekilmeden hemen önce intraperitoneal ve operasyon sonunda insizyonel levobupivakain uygulandı. Grup C kontrol grubu olarak kabul edildi. Ameliyat sırasında değişkenler, ameliyat sonrası ağrı sağaltımı, ek anal jezik tüketimi ve hasta memnuniyetine ilişkin veriler karşılaştırıldı. Bulgular: Ameliyat sırasında fentanil tüketimi Grup BS de Grup AS ve Grup C ye göre daha az bulundu (p

Laparoskopik kolesistektomi ağrısı: Cerrahi öncesi veya sonrasında uygulanan insizyonel ve intraperitoneal levobupivakain kombinasyonunun etkisi

Objectives: We aimed to investigate whether the timing of administration, using a combination of incisional and intraperi- toneal levobupivacaine (0.25%), has an effect on the postoperative pain after laparoscopic cholecystectomy in a prospective, randomized, and controlled study. Methods: Sixty six patients were allocated to one of the three groups. Group BS received levobupivacaine before trocar site incision and intraperitoneal levobupivacaine immediately after pneumoperitoneum. Group AS received intraperitoneal levobupivacaine before trocars were withdrawn and incisional levobupivacaine administered at the end of surgery. Group C received no treatment. Data of intraoperative variables, postoperative pain relief, rescue analgesic consumption, and patient satisfaction were compared. Results: The intraoperative fentanyl consumption was found lower in Group BS, compared to Groups AS and C (p<0.05). VAS scores were lower in both Groups BS and AS, compared to Group C immediately after the operation (p<0.05). VAS scores were significantly decreased during the first two hours in Group AS, compared to Group C. The mean doses and num- ber of patients needing rescue meperidine were lower in Group AS, compared to the Groups BS and C (p<0.05). Conclusion: The combination of incisional and intraperitoneal levobupivacaine administered before or after surgery can reduce postoperative pain and analgesic and antiemetic consumption together with improved patient satisfaction. However, administering levobupivacaine before surgery might be advantageous for less intraoperative fentanyl consumption, while le- vobupivacaine after surgery is advantageous for less postoperative rescue analgesic requirement.

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