Ibrahim Ibrahim Abd El BASER, Ahmed SADEK, Alaa MAZY

The Effect of Gall Bladder Bed Infiltration on Analgesia in Laparoscopic Cholecystectomy

Objective: Gallbladder is highly innervated by parasympathetic and sympathetic nervous systemthrough anterior and posterior hepatic plexus and the phrenic nerves. The aim of the currentstudy is to evaluate the efficacy of infiltration of lidocaine into gallbladder bed in controllingpostoperative abdominal pain and reducing analgesic consumption following laparoscopic cholecystectomy.Methods: This randomized prospective double-blind study was conducted on 70 patients appliedfor laparoscopic cholecystectomy. Six patients were excluded or dropped out and the patientswere allocated into 2 groups as control group (n=32) in which gallbladder bed was infiltrated withnormal saline and infiltration group (n=32) in which lidocaine was infiltrated into gallbladder bed.Pain within the first postoperative 24 hours, time to the need for first rescue analgesia and analgesic consumption were recorded.Results: The postoperative visual analogue score within the first 24 hour for visceral pain at rest,during coughing, and movement was significantly lower in the infiltration group than the controlgroup, but it was similar for somatic pain. Time to first rescue analgesia was significantly longerin the infiltration than the control group. Significantly smaller number of patients required morphine and the total dose of postoperative analgesic consumption was lower in the infiltrationthan the control group.Conclusion: Gallbladder bed infiltration with lidocaine was associated with decreased visceralpain intensity at rest, coughing, and movement with reduced analgesic consumption in the firstpostoperative 24 hours.

Laparoskopik Kolesistektomide Safra Kesesi Yatağı İnfiltrasyonunun Analjezi Üzerine Etkisi

Amaç: Safra kesesi, anterior hepatik pleksus, posterior hepatik pleksus ve frenik sinirler yoluyla parasempatik ve sempatik sinir sistemi tarafından yüksek oranda innerve edilir. Bu çalışmanın amacı, laparoskopik kolesistektomi sonrası postoperatif abdominal ağrıyı kontrol altına almak ve analjezik tüketimini azaltmak için safra kesesi yatağına lidokain infiltrasyonunun etkinliğini değerlendirmektir. Yöntem: Bu randomize prospektif çift kör çalışma, laparoskopik kolesistektomi için başvuran 70 hasta üzerinde yapıldı, 6 hasta çalışma dışı bırakıldı veya çalışmadan ayrıldı. Hastalar safra kesesi yatağına normal salin infiltre edilen kontrol grubu (n=32) ve lidokain infiltre edilen infiltrasyon grubu olarak 2 gruba ayrıldı (n=32). Postoperatif ilk 24 saatte, postoperatif ağrı, ilk kurtarıcı analjezi süresi ve analjezik tüketimi kaydedildi. Bulgular: Postoperatif ilk 24 saatte, postoperatif visual analog skor, visseral ağrı için, istirahatte, öksürme ve hareket esnasında infiltrasyon grubunda kontrol grubuna göre anlamlı olarak düşüktü ve somatik ağrı için benzerdi. İlk kurtarıcı analjezi süresi infiltrasyonda kontrol grubuna göre anlamlı olarak daha uzundu. Kontrol grubuna göre infiltrasyon grubunda, morfin ihtiyacı olan hasta sayısı anlamlı derecede daha azdı ve postoperatif analjezik tüketiminin toplam dozu daha düşüktü. Sonuç: Lidokain ile safra kesesi yatağı infiltrasyonu, postoperatif ilk 24 saatte istirahatte, öksürme ve hareket esnasında viseral ağrı yoğunluğunun ve analjezik tüketiminin azalması ile ilişkiliydi.

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