A STUDY OF EFFECTIVENESS OF LOCAL BUPIVACAINE INFILTRATION OF THE WOUND IN REDUCING THE POST OPERATIVE PARENTERAL NARCOTIC ANALGESIC REQUIREMENT

Objective: To see the effectiveness of local perfusion of the wound with bupivacaine .5% following cholecystectomy was studied.Material and Methods: A prospective randomized clinical trail involving 140 patients undergoing cholecystectomy for symptomatic gallstones, using Kocherʹs incision, was undertaken. Patients were randomized to receive either intermittent intravenous tramadol infusion on demand (parenteral analgesia, PA-group) or wound perfusion with local bupivacaine .5% per-operatively followed by intravenous tramadol infusion, if needed (local analgesia, LA-group). On hundred and forty patients were recruited in the study, 70 in each group. Patient demographics were comparable in the two groups.Results: There was no statistically significant difference in post-operative pain scores at rest and with movement between the two groups, excepts for pain scores at rest on the first post-operative day (P = 0.03). The median total amount of tramadol used was significantly greater in PA group i.e. 600 (range 500-1000) mg as compared to the amount used in LA-group i.e. 200 (range 0-400) mg.Conclusion: Direct local wound perfusion of bupivacaine 0.5% provides good pain relief after cholecystectomy and reduces the requirements of parenteral narcotic analgesia with no major side effect. In other words it is a safe and feasible alternative to parenteral opiods.