Although
pain after
laparoscopic cholecystectomy is less intense than after open
cholecystectomy, some patients still experience considerable discomfort. Furthermore, the characteristics of postlaparoscopy
pain differ considerably from those seen after
laparotomy. Therefore, we investigated the time course of different
pain components after
laparoscopic cholecystectomy and the effects of intraperitoneal
bupivacaine on these different components. Forty ASA physical status grade I-II patients were randomly assigned to receive either 80 mL of
bupivacaine 0.125% with
epinephrine 1/200,000 (n = 20) or the same volume of saline (n = 20) instilled under the right hemidiaphragm at the end of surgery. Intensity of total
pain, visceral pain, parietal
pain, and
shoulder pain was assessed 1, 2, 4, 6, 8, 24, and 48 h after surgery.
Analgesic consumption was also recorded. Patient data were similar in the two groups. In the saline group,
visceral pain was significantly more intense than parietal
pain at each time point; visceral and parietal
pain were greater than
shoulder pain during the first 8 h postoperatively. Intraperitoneal
bupivacaine did not significantly affect any of the different components of
postoperative pain.
Analgesic consumption was similar in the two groups. This study demonstrates that
visceral pain accounts for most of the
pain experienced after
laparoscopic cholecystectomy. Intraperitoneal
bupivacaine is not effective for treating any type of
pain after
laparoscopic cholecystectomy.