A comparison of interpleural bupivacaine and intravenous pethidine for postoperative pain relief following open cholecystectomy

Introduction: Open cholecystectomy is still a fairly frequently performed operation in the developing world. It is more invasive and therefore associated with a greater degree of postoperative pain. The purpose of this study was to compare the efficacy of a single dose of 20 ml 0.5% interpleural bupivacaine with a single 1 mg/kg bolus of intravenous pethidine for postoperative pain relief following open cholecystectomy.
Material and methods: The study consisted of 100 randomly selected ASA physical status I/II male/female adults, aged 30-60 years, diagnosed with chronic cholecystitis and scheduled for surgery. Group I received a single 20 ml 0.5% bolus of bupivacaine into their interpleural space (n = 50). Group II received a single bolus of 1 mg/kg body weight of intravenous pethidine (n = 50). Visual analogue scale (VAS) scores, pulse rate (PR) and mean arterial pressure (MAP) were recorded and compared between and within study groups at pre-induction, immediately after administration of study drugs at time increments of 5, 15, 30, 60, 120, 240 and 360 min.
Results: Lower VAS scores, longer duration of analgesia (4 h 37 min), significant attenuation of hemodynamic responses, and no incidence of complications were observed among patients who received interpleural bupivacaine.
Conclusions: Interpleural bupivacaine is a better choice than intravenous pethidine for post-operative pain relief following open cholecystectomy. Further studies should be conducted with a special attention to long-term side effects and complications with respect to their routes of administration. The knowledge of open cholecystectomy and its postoperative profile remains vital to the knowledge base of physicians, particularly, in the developing word.