Consultant General & Colorectal Surgeon Department of General Surgery, Dr. Grays Hospital (NHS Grampian), Elgin UK
What to prefer Bupivacaine or Bupivacaine and Buprenorphine in the management of Pain after Laparoscopic Cholecystectomy
Background: An unpleasant sensory and emotional experience arising from actual or potential tissue damage. Pain is a highly personal, subjective experience which can only be accurately described by the individual who is experiencing pain. Post-operative pain is one of the commonest entity to deal with and there are number of drugs that can be added. Bupivacaine and Buprenorphine have shown promising results.
Objective: To compare the mean duration of post-operative analgesia in patients receiving intra-peritoneal bupivacaine/ bupivacaine plus buprenorphine in laparoscopic cholecystectomy.
Method: Patients Age between 18- 60 years undergoing elective laparoscopic cholecystectomy were studied, they were divided into two groups. The cases in group A were given Bupivacaine 0.25% and those in group B were given Bupivacaine 0.25% and Buprenorphine. Duration of post-operative analgesia was noted.
Inclusion criteria:
1. Patients of both genders with ages in the range of 18-60 years undergoing elective laparoscopic cholecystectomy
2. Patients who sign written informed consent.
Exclusion criteria:
1. Allergy to bupivacaine, Steroid intake.
2. Deranged coagulation profile
3. ASA Class ≥III
Results: In this study there were 60 cases, equally divided between two groups (30 in each group). There were 14 (46.67%) males in group A vs 13 (43.33%) in group B with mean age of 45.67±11.12 group A and 44.89±9.66 in group B. Mean duration of post-operative analgesia was 3.14±0.71 vs 8.97±1.13 in group A and B with p= 0.001. Mean duration of post-operative analgesia in males was 3.19±0.81 vs 9.02±0.91 and in females 3.02±0.67 vs 8,34±0.56 in group A and B with p values of 0.001 and 0.003 respectively. This duration of analgesia was also significantly high in both age groups i.e. 20-39 years and 40-60 years with p values of 0.001 and 0.002 respectively. Post-operative analgesia duration was much better in group B in BMI less than 30 was 9.97±1.23 vs 3.87±1.13 with p= 0.001 and in BMI 30 or more this was 8.11±0.94 vs 2.97±0.43 in group B and A respectively with p= 0.01.
Conclusion: Mean duration of post-operative analgesia was significantly better in cases treated with intra peritoneal bupivacaine and buprenorphine as compared to bupivacaine only and this difference is significantly better in all the confounding variable like age, gender and BMI.
Keywords: Bupivacaine, Buprenorphine, VAS.