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KMID : 0363120080210010044
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Korean Journal of Pain
2008 Volume.21 No. 1 p.44 ~ p.50
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The Effect of Intraperitoneal Instillation and Trocar Site Infiltration of 0.25%Levobupivacaine on the Postoperative Pain after Performing Laparoscopic Cholecystectomy under Remifentanil Based Anesthesia
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Lee Cheol
Song Yoon-Kang
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Abstract
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Background: The use of regional local anesthetics or opioids during laparoscopic cholecystectomy (LC), in
combination with general anesthesia, has been investigated in several interventional studies.
Methods: We studied a total of 240 (n = 60, each) patients who were undergoing LC, and they received
local infiltration and intraperitoneal instillation with normal saline or 0.25% levobupivacaine 60 ml. Group R (S)
received infiltration of normal saline 20 ml before incision and at the end of surgery and then 40 ml intraperitoneal
instillation after removal of the gall bladder under remifentanil-based anesthesia. Group R (L) received 0.25%
levobupivacaine instead of normal saline in the same method like group R (S). Group S (S) received the same
method as group R (S) under sevoflurane based anesthesia in place of remifentanil. Group S (L) received 0.25%
levobupivacaine instead of normal saline with the same method as group S (S). Pain was assessed on a visual
analog scale at 1, 6, 12 and 24 hours after operation.
Results: The pain intensity of Group R (L) was significantly lower than that of group R (S), and the the incisional
pain of group S (L) was significantly lower than that of group S (S) in the first six hours. The time delay to
first operative analgesics in group R (S) and group S (S) was significantly shorter than that of group R (L) and
group S (L).
Conclusions: Infiltration and instillation of levobupivacaine reduced the postoperative pain and remifentanil
did not increase the pain severity and opioid requirement when performing the LC. (Korean J Pain 2008; 21:44?50)
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KEYWORD
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laparoscopic cholecystectomy, levobupivacaine, postoperative pain, remifentanil
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