Study On The Comparison Of Bupivacaine And Parecoxib For Postoperative Pain Relief After Laparoscopic Cholecystectomy

Objective:Pain is the most common complaint of patients on the first day after laparoscopic cholecystectomy(LC).The aim of this study was to compare the efficacy and safety of local anesthesia with bupivacaine and intravenous parecoxib on postoperative abdominal pain relief up to 24 h after surgery.Methods:One hundred and eighty patients who received treatment in Shanghai Tenth Peoples Hospital of Tongji University and underwent LC from March 2013 to May 2015 were randomizelly divided into three groups with sixty patients in each. Each patient in Group A received 50 mg 0.5% bupivacaine subcutaneously at trocar sites before incision closure; each patient in Group B received intravenous parecoxib(40 mg) after entering the recovery room; each patient in Group C did not receive postoperative analgesia unless needed and was served as control. The postoperative pain at 1, 2, 4, 8, 12, and 24 h after the operation was assessed using a visual analog scale(VAS). Secondary outcomes, including intraoperative and postoperative complications, operation time, anesthesia time, intraoperative blood ? spilt, pneumoperitoneum pressure, bile spillage, washout, time of removing gallbladder, postoperative activity time, hospital stay, and the incidence of shoulder pain, pethidine requirements, postoperative nausea and vomiting were also recorded.Results:1. There were no significant difference on the gender, age, BMI,ASA grade, anesthesia time, operation time and postoperative activity time among three groups(P>0.05).2.At 1, 2, and 4 hours after surgery, VAS pain scores were significantly lower in group A and B compared with group C(P<0.05 for all). There was no significant difference among the three groups at 8, 12, and 24 hours after the procedure(P>0.05 for all). At 1, 2 hours after surgery, VAS pain scores were significantly lower in group A compared with group B(P<0.05 for all). A repeated- measures ANOVA analysis revealed that VAS pain scores over the first 24 hours after LC were significantly lower in group A and B compared with group C(P<0.05 for all).3. There were no significant difference on the bile spillage, intraoperative blood?spilt, washout, time of removing gallbladder, hospital stay, incidence of postoperative nausea and vomiting among three groups(P>0.05). The incidence of shoulder pain in Group A was significantly lower than that in Group B(P<0.05).There were no serious untoward effects in intraoperative and intraoperative 24 hours, and also side effects induced by trail drugs was not found. All patients presented two weeks after surgery in the outpatient department, and no untoward or major complications were observed.4.There was significant difference on the usage rate of pethidine requirements in postoperative 24 hours, and the rate was significantly higher in group C as compared with group A and group B(P<0.05).Conclusion:1. Local anesthesia with bupivacaine at trocar sites and intravenous parecoxib can both relieve acute incision pain after LC, bupivacaine and parecoxib has similar analgesic effect.2. It is safe of useing bupivacaine and parecoxib for postoperative abdominal pain relief up to 24 h after surgery, can contribute to decreases dosage of analgesics for the patients who require postoperative rescue analgesics, and do not increase the untoward effect.