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Research Article

Intra-peritoneal bupivacaine in management of post operative shoulder tip pain following diagnostic laparoscopic procedure – a triple blind randomized control trial

Authors:

A. H. M. Makarima ,

Castle Street Hospital for Women, Colombo, LK
About A. H. M.
Senior Registrar in Obstetrics and Gynaecology
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D. M. S. T. Gnanarathne,

District Hospital Dickoya, LK
About D. M. S. T.
Consultant Obstetrician and Gynaecologist
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S. Hemapriya

General Hospital Kandy, LK
About S.
Consultant Obstetrician and Gynaecologist
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Abstract

Background: Post-operative shoulder-tip pain (STP) is a frequent complication following laparoscopy resulting in significant morbidity. This trial evaluates Intra-Peritoneal Bupivacaine (IPB) as a method of relieving post-operative STP.

 

Methods: Fifty-eight patients undergoing diagnostic laparoscopies were randomized to Group A (treatment) and Group B (control). Group A (n = 28) received 0.25% bupivacaine and Group B (n =30) received an equal volume (10ml) of normal saline as an intra-peritoneal instillation in to the sub diaphragmatic space under direct vision. STP was recorded by using a visual analogue pain scale (VAS) at 0 hour, 4 hours, 8 hours of surgery, and at the time of discharge. Post-operative morbidity was assessed by additional analgesia and time taken for independent mobilisation.

 

Results: The incidence rate of STP in control group (B) was 70% while only 25% (7 out of 28) had reported STP in treatment Group (A), which is statistically significant (P = 0.001). Both severity of STP (P=0.004) and post-operative additional analgesia (P=0.001) were significantly higher in control group (B). Group A had an early mobilization (Mean Hours 9.43). Among the adverse effects studied, only nausea was reported higher in Group A (P<0.05).

 

Conclusion: Per-operative intra-peritoneal instillation with bupivacaine significantly reduces both frequency and severity of STP following diagnostic laparoscopy while improving post-operative morbidity.
How to Cite: Makarima, A.H.M., Gnanarathne, D.M.S.T. and Hemapriya, S., 2019. Intra-peritoneal bupivacaine in management of post operative shoulder tip pain following diagnostic laparoscopic procedure – a triple blind randomized control trial. Sri Lanka Journal of Obstetrics and Gynaecology, 41(2), pp.42–48. DOI: http://doi.org/10.4038/sljog.v41i2.7886
Published on 18 Jul 2019.
Peer Reviewed

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