PAIN MANAGEMENT FOLLOWING LAPAROSCOPIC CHOLECYSTECTOMY; KETOROLAC VERSUS INTRAPERITONEAL BUPIVACAINE

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Abstract

ABSTRACT
Background: Laparoscopic cholecystectomy (LC) has been through tremendous advancement over the last two
decades. However, the management paradigm has been transitioning to day-care LC, for which postoperative pain
management plays the central role.
Objective: Our aim was to investigate the role of intravenous Ketorolac and intraperitoneal bupivacaine instillation in
providing effective pain relief.
Methods: This is a prospective randomised study of 6-month duration (July-December 2012) was conducted by the
joint collaboration of Department of Anaesthesia, Hayatabad Medical Complex Peshawar and Surgical unit of the same
institute where we randomly allocated patients undergoing laparoscopic cholecystectomy to either of two postoperative
analgesia groups. Group 1 was patients who were given postoperative intravenous ketorolac (30 mg, 8 hourly) and
group 2 was patients who were provided with intraperitoneal 0.5% bupivacaine solution at the end of the procedure.
Pain relief was measured using the visual analogue scale (VAS) at 1st, 6th, 12th and 24th hour of the operation.
Results: Of the 80 patients, there were 30 (37.5%) males and 50 (62.5%) females with a male to female ratio of 1: 1.67.
The overall mean age was 41.49 years ± 7.65 SD.Overall mean VAS at 1st hour was 3.47 ± 1.16 SD, at 6th hour was
2.64 ± 0.97 SD, at 12th hour was 2.4 ± 0.91 and at 24th hours it was 1.80 ± 0.75 SD.no differences were found for
pain scores at the 1st hour postoperatively (p = 0.27). Similarly, no significant differences were noted for either group
in terms of length of hospital stay (p = 0.50).Significantly lower VAS at 6-hour postoperatively was recorded for group
2 as compared to group 1 (p < 0.0001). At the 12th hour postoperatively, however, lower mean pain scores were found
for Group 1 (p<0.0001).
Conclusions: The use of intravenous ketorolac is effective due to its longer time of action. However, intraperitoneal
instillation of bupivacaine has also favourable effects upon the overall pain relief and reduced need for rescue analgesic

Authors: 
Rafi Ur Rehman
Muhammad Iftikhar3
Journal Issue: