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