Intraperitoneal local anaesthetic instillation versus no intraperitoneal local anaesthetic instillation for laparoscopic cholecystectomy

Ideal Local Anesthetic for Intraperitoneal Gallbladder Bed Infiltration Following Laparoscopic Cholecystectomy: A Randomized Controlled Trial

Background Laparoscopic cholecystectomy is the gold standard operation for symptomatic cholelithiasis; however, pain remains a major factor in increasing morbidity and length of hospital stay. Infiltration of the gallbladder bed with a local anesthetic has been shown to improve postoperative pain after laparoscopic cholecystectomy, although it is unclear which local anesthetic provides superior pain relief. Objective The aim of this study was to compare the efficacy of various local anesthetics on postoperative pain when instilled intraperitoneally in the gallbladder bed following laparoscopic cholecystectomy. Methods Patients undergoing laparoscopic cholecystectomies were randomized into three groups of 30 patients each, depending on the local anesthetic instilled in the gallbladder bed: lignocaine (Group A), bupivacaine (Group B), or a combination of lignocaine and bupivacaine (Group C). Pain was measured using the Visual Analogue Scale (VAS) at two, six, 12, and 24 hours following surgery. Secondary outcomes included vitals, rescue analgesic use, return of bowel function, time to ambulation, and presence of nausea. Results Group C showed the lowest pain scores at all time points compared to the other groups (p < 0.05). Mean arterial pressures and heart rates were lower in Group C than in Group A at two and 24 hours. Return of bowel function and time to ambulation was earlier in Group C than in Group B. No significant complications were noted in any of the groups. Conclusion We conclude that a combination of lignocaine and bupivacaine instillation in the gallbladder bed provides the most effective pain relief following laparoscopic cholecystectomy, without significant complications at the doses used.

Day-case laparoscopic cholecystectomy in the management of gallbladder disease: a literature review

BACKGROUND

Day-case laparoscopic cholecystectomy (DCLC) has gained traction globally due to its benefits, including shorter hospital stays, reduced costs, and enhanced patient experience. While concerns about patient safety, particularly related to bleeding and bile duct injury persist, the literature supports the efficacy and advantages of DCLC highlighting the need for its wider adoption in healthcare settings to optimise resources and improve patient outcomes.

METHODS

This was a literature review that aims to assess the feasibility and safety of day-case laparoscopic cholecystectomy for symptomatic gallstone patients, focusing on incidence and aetiology of unexpected admissions and readmissions, as well as conversion-to-open rates. PubMed was searched for all studies focusing on DCLC between 2014 and 2024. The timeframe was specifically selected to identify recent trends and practices in this evolving field. By focusing on this specific period, the review aims to provide a comprehensive analysis of current practices, emerging trends, and the evolving standard of care in this area.

RESULTS

This review highlights that the main causes of unexpected admission post DCLC were postoperative nausea, vomiting, and pain, while the implementation of anaesthetic pathways notably increased day-case rates. Studies addressing complication rates postoperatively consistently found no significant difference between day-case and in-patient procedures.

CONCLUSIONS

DCLC for symptomatic gallstone patients is supported by research as safe and effective, with high success rates and patient satisfaction. Studies show minimal complications and acceptable readmission rates, suggesting that DCLC can be the standard approach for selective patients, improving outcomes and healthcare efficiency.

Effect of Intraperitoneal Local Anesthetics in Laparoscopic Bariatric Surgery: A Meta-Analysis of Randomized Controlled Trials

OBJECTIVE

The effectiveness of intraperitoneal local anesthesia (IPLA) has been confirmed in other fields, but its use in bariatric surgery remains debatable. This study aimed to evaluate the analgesic effect of IPLA in bariatric surgery.

METHODS

PubMed, Web of Science, Embase, and the Cochrane Library were searched from inception to February 2022. All randomized controlled trials (RCTs) assessing IPLA's analgesic effect in bariatric surgery were included in this study. Pain-related indicators were the outcome.

RESULTS

Ten RCTs with 979 patients were included. Postoperative pain scores were significantly lower in IPLA group. Subgroup analysis demonstrated that IPLA was associated with lower pain scores in 6 h and at 24 h compared to the control group, without significant differences at 8, 12, and 48 h. Meanwhile, IPLA reduced the dose of opioids taken postoperatively. Additionally, there were no differences in adverse events between the two groups. As far as the number of postoperative analgesics used and hospital stays were concerned, our results did not show statistical differences between the two groups.

CONCLUSION

IPLA can reduce postoperative pain safely and effectively, particularly during the early postoperative stage.