DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20161990

A comparison of intravenous lignocaine, intraperitoneal lignocaine, a combination of both on bowel recovery and pain relief in patients undergoing laparoscopic cholecystectomy

Unnikrishnan E. Puram, Rajesh M. Raghavan, Anoop M. Appunny

Abstract


Background:Laparoscopic cholecystectomy (LC) is being increasingly performed as a day care surgery. Pain and lack of early bowel movements are common reasons preventing discharge on the same day.

Methods: Study was conducted in a Government tertiary care institute in Kerala, South India. The effect of Intraperitoneal (IP), Intravenous (IV) and a combination of both on postoperative pain relief and bowel recovery was studied in 75 patients who were randomized in to 3 equal groups undergoing elective laparoscopic cholecystectomy. Group 1 IP lignocaine, Group 2 IV lignocaine and Group 3 combination of IP and IV lignocaine.

Results: The time of bowel recovery and the pain scales at different time was compared using ANOVA test. Intergroup comparison of bowel recovery and pain scale was done using Bonferroni test. Pain score shows a statistically significant difference between Group 1 and Group 2 with a p value <0.001 and a statistically significant difference between Group1 and Group3 with a p value 0.126, but no statistical significance between Group 2 & Group3. The return of bowel activity was noted with perception of bowel movements and time for passage of flatus compared among the group, there was a statistically significant difference between the three groups.  Group 2 was found to be significantly better than the Group1 and Group3.

Conclusions: Intravenous lignocaine is superior in bringing out early return of bowel activity when compared to all groups and Intravenous lignocaine is superior compared to intraperitoneal lignocaine in pain relief.

 


Keywords


Laparoscopic cholecystectomy, Intravenous lignocaine, Intraperitoneal lignocaine, Pain

Full Text:

PDF

References


Semm K. Atlas of Gynecologic laparoscopy and hysteroscopy. Philadelphia: WB Saunders, 1977:7-14.

Edmonson JM. History of the instruments for gastrointestinal endoscopy. Gastrointest Endosc 1991;37(2 suppl):S27-26.

Jensen K, Kehlet H, Lund CM. Postoperative recovery profile after laparoscopic cholecystectomy: a prospective, observational study of a multimodal anaesthetic regime. Acta Anaesthesiol Scand. 2007;51(4):464-71.

Wills VL, Hunt DR. Pain after laparoscopic cholecystectomy. Br J Surg. 2000;87(3):272-84.

Cook AK, Niven CA, Downs MG. Assessing the pain of people with cognitive impairment. Int J Geriatr Psychiatry. 1999;14:421-25.

Kaba A, Laurent SR, Detroz BJ, Sessler DI, Durieux ME, Lamy ML et al. Intravenous lidocaine infusion facilitates acute rehabilitation after laparoscopic colectomy. Anesthesiology. 2007;1106:11-8.

Kahokehr A, Sammour T, Soop M, Hill AG. Intraperitoneal use of local anesthetic in laparoscopic cholecystectomy: systemic review and meta-analysis of randomized controlled trials. J Hepatobiliary Pancreat Sci. 2010;17(5):637-56.

Elhakin M, Elkott M, Ali NM, Tahoun HM. Intraperitoneal lidocaine for postoperative pain after laparoscopy. Acta Anaesthesiol Scand. 2000;44:280-4.

Ahmed BH, Ahmed A, Tan D, Awad ZT, Al-Aali AY, Kilkenny J. Post-laparoscopic cholecystectomy pain: effects of intraperitoneal local anesthetics on pain control- a randomized prospective double-blinded placebo-controlled trial. Am Surg. 2008;74:201-9.

Marret E, Rolin N, Beaussier M, Bonnet F. Meta-analysis of intravenous lidocaine and postoperative recovery after abdominal surgery. Br J Surg. 2008;95:1331-8.

Wu CT, Borel CO, Lee MS, yu JC, Liou HS, Yi HD et al. The interaction effect of perioperative cotreatment with dextromethorphan and intravenous lidocaine on pain relief and recovery of bowel function after laparoscopic cholecystectomy. Anesth Analg. 2005;100:448-53.

Rimback G, Cassuto J, Tollesson PO. Treatment of postoperative paralytic ileus by intravenous lidocaine infusion. Anesth Analg. 1990;70:414-9.

Kin TH, Kang H, Hong JH, Park JS, Baek CW, Kim JY, Jung YH, Kim HK. Intraperitoneal and intravenous lidocaine for effective pain relief after laparoscopic appendectomy: a prospective, randomized, double-blind, placebo-controlled study. Surg Endosc. 2011;25(10):3183-90.

Wulf H, Leger R, Raetzell M, Olmer A, Scheiderer U. Cholestasis as a side effect of bupivacaine? Reg Anesth Pain Med. 1998;23:278-82.