Pain Relief in Laparoscopic Cholecystectomy: Pre-emptive Versus Post-operative Local Anaesthetic Infiltration—A Randomized Control Trial

Introduction

Laparoscopic cholecystectomy, a widely performed procedure globally, often results in post-operative pain, which impacts the length of hospital stay and imposes financial burdens. This randomised controlled trial aimed to compare the effects of pre-emptive versus post-operative local anaesthetic infiltration at port-site incisions on post-operative pain in laparoscopic cholecystectomy patients.

Patients and methods

This double-blinded study, conducted at a tertiary care hospital, included 50 patients scheduled for laparoscopic cholecystectomy and were divided into two groups: Pre-emptive analgesia (group A) and post-operative analgesia (group B). Randomization was performed with sealed envelopes, and patients were evaluated preoperatively. Pain scores, shoulder pain incidence, hospital stay duration, analgesic requirements, and return to normal activity were compared between the groups.

Results

Baseline demographic profiles were comparable. Pre-emptive analgesia demonstrated significantly lower Visual Analogue Scale scores at 1, 3, 6, 12, 24 h, and 7 days post-operatively with no significant difference in shoulder pain incidence. Pre-emptive analgesia correlated with a markedly shorter hospital stay reduced analgesic requirements, and an earlier return to normal activity. Only 10% of patients from the post-operative analgesia group required additional analgesia.

Conclusion

Pre-emptive local anaesthetic infiltration at port sites yielded significant benefits, including reduced pain, lower analgesic requirements, shorter hospital stays, and earlier resumption of routine activities compared to post-operative infiltration.

Trial Registration

This project is registered under the Clinical Trial Registry-India (CTRI) CTRI Number: CTRI/2023/08/056175 [Registered on: 07/08/2023]—trial registered prospectively