Intra-peritoneal Xylocaine Spraying for Postoperative Pain Control in Laparoscopic Cholecystectomy: A prospective study at Al-Yarmouk Teaching Hospital
Background: The concept of minimal access surgery was introduced to achieve several objectives; among which was to minimize post-operative pain by bringing access trauma to the lowest possible level without compromising the clarity of the operative field. Objectives: To study the effect of using local intraperitoneal application of xylocaine, in 2 different concentrations applied directly as near as possible to the intra-abdominal operative field in laparoscopic cholecystectomy, on post-operative pain control. Patients and methods: 110 patients with symptomatic gall stone disease were treated with laparoscopic cholecystectomy. These were divided into 3 groups, the first group, of 40 patients, was operated upon using the classical steps of that surgery and the final step was always to wash the field with normal saline followed by sucking extra fluid before terminating the surgery. In the second group (36 patients) a step was added; and that is the application of local Xylocaine (3 ml of 2% solution-without adrenaline- diluted with 7 ml of normal saline to a total of 10 ml- i.e. 0.6% solution) sprayed as near as possible to gall bladder bed (after excising the gall bladder) and kept in. In the third group (34 patients), 5 ml of the 2% Xylocaine were diluted up to 10 ml (ending with a 1% solution) sprayed in the same way. These 3 groups were followed post-operatively regarding the level of pain and magnitude of post-operative pain control and the amount of post-operative analgesia needed for each of them. Results: The first group of patients who did not receive intraperitoneal xylocaine, expressed higher levels of post-operative pain, and needed higher (or more frequent) doses of post-operative analgesia, than the 2nd and the 3rd groups who did receive intra-peritoneal xylocaine sprays. This was expressed as better post-operative pain control in these patients. There was no significant difference in pain control between the 2nd and the 3rd group patients. Using this simple technique will add no more than a minute or two to the time of the operation at its end. Pain control will be significantly aided if subcutaneous Xylocaine was also used in addition at the port site wounds. Conclusions: Using local intraperitoneal xylocaine sprayed at the gall bladder bed in laparoscopic cholecystectomy (as the end step after excising the gall bladder) gives a better post-operative pain control and decreases the need for higher or more frequent doses of post-operative analgesia.