INTRAPERITONEAL USING OF BUPIVАCAIN FOR THE ANESTHESIA OF PATIENTS AFTER LAPAROSCOPIC CHOLECYSTECTOMY

Abstract

Relevance. The local anesthetics were used intraperitoneally after some minimally invasive gynecological interventions like a component of postoperative multimodal anesthesia in recent years. Objective. The aim of work was to study the effectiveness of intraperitoneal administration of bupivokain for the anesthesia of patients after laparoscopic cholecystectomy. Material and methods. 28 patients aged 32-60 years (16 women, 12 men) were examined. The patients were divided into two groups. In the first group for anesthesia after the operation, was used ketorolac trometamine in dose 0.2 mg/kg intramuscularly each 6 hours. If the patient complained of postoperative pain, which was assessed by Visual-analog scale in 7 points or higher, fentanyl was administered intramuscularly in dose of 0.003 μg/kg. In the second group, besides the components of multimodal anesthesia used in the first group, at the end of the surgical intervention at the drainage tubes were injected 40 ml of 0.125% solution of bupivocaine (50 mg). This injection was repeated throughout the first day each 6 hours. The condition of patients was assessed by a Visual-analog scale after 1, 4, 8, 12 and 24 hours after the finishing of surgery. The average dose of fentanyl in μg/kg used for postoperative anesthesia first 24 hours after operation was also determined. Results. We have received a significant reduction in the rates of pain evaluation for Visual-analog scale in patients who used bupivacaine as a component of multimodal anesthesia. One hour after the end of the operation, the pain score for Visual-analog scale was less than the corresponding one in the control group in 1.77 times, after 4 hours – in 1.47, and in 8 hours – in 1.55 times. In all cases, P <0.001. The mean dose of fentanyl used for treatment in the study group was 1.55 times less than that in the control group. There were no significant complications in both groups. A patient in group 1 had nausea, requiring a single dose of ondasetron 2 mg Conclusion. Intraperitoneal administration of bupivocaine had a significant anesthetic effect after laparoscopic cholecystectomy.

Keywords

• postoperative pain, vas scale, intraperitoneal injection, bupivacaine, multimodal anesthesia