Objectives: To evaluate postoperative outcome of open cholecystectomy in patients received local
anesthetic (LA) wound irrigation (WI) for postoperative (PO) analgesia.
Patients & Methods: The study included 40 female patients with mean age of 34.1t3.4 years. All
surgeries were performed through Kocher's subcostal incision, prior to muscle cutting, the
neurovascular was identified and after peritoneal drainage and closure, an 8F neonatal feeding catheter
with fashioned multiple pores was inserted partly between anterior abdominal wall muscles and partly
under subcutaneous tissue directly on the neurovascular bundle. Patients were divided into: Control
group (Group C) received WI using 0.9% saline and Study group (Group S) received 8-hourly WI
using 20 ml of bupivacaine 0.25% for 48 hours. Wound pain was assessed using 10-mm visual
analogue scale (VAS). Duration of PO analgesia and frequency of requests and total dose of
intravenous mepridine, time for first ambulation and oral intake were recorded. All patients were
discharged after irrigation catheter removal on the morning of the 3n1 P0 day.
Results: All surgeries were completed uneventfully without complications within a mean operative
time of 46.5+5.3 minutes. Patients received LA irrigation showed significantly longer duration of
analgesia with significantly lower frequency of requests and total dose of mepridine and lower
cumulative VAS pain score compared to control group. Mean time till 1“ ambulation and oral intake
was significantly shorter in Group S compared to group C. Seven patients had postoperative nausea
and/or vomiting (PONV), 4 in control and 3 in study group and only one patient in control group
required stoppage of oral intake, but all patients responded well to antiemetic therapy.
Conclusion: Wound irrigation with bupivacaine significantly improved outcome of open
cholecystectomy and could be advocated for various open surgical procedures. The applied modality
was safe, effective and cost reducing with significant opioid sparing effect. |
