Determining a Method to Minimize Pain After Laparoscopic Cholecystectomy Surgery

Background: Although many studies have investigated control of postoperative pain, inadequacy of treatment still remains. In this study, we aimed to identify a method with the capacity to minimize abdominal and right shoulder pain after laparoscopic cholecystectomy. Materials and Methods: A total of 684 subjects, 77% (n=527) female and 23% (n=157) male, were included in this study. A T-drain was prescribed for patients requiring bile duct exploration and patients with acute cholecystitis were excluded from the study. Subjects were classified into groups as follows: Group 1: control group without drain and intraperitoneal analgesics; Group 2: a drain was placed but no intraperitoneal analgesic was applied; Group 3: no drain was placed and intraperitoneal subhepatic bupivacaine was applied; and Group 4: drain was placed and intraperitoneal subhepatic bupivacaine was applied. Parietal pain and visceral pain were evaluated with visual analog scale (VAS). Results: A drain was present in 51.9% (n=355) of the cases. A statistically significant difference was found between the preoperative pulse rate measurements of the cases according to the groups (P=0.009; <0.01). Subhepatic bupivacaine was administered in 50.1% (n=355) of the cases. A statistically significant difference was found between the second, fourth, sixth, 12th, and 24th hour VAS scores of the cases according to the groups [2 h VAS scores (mean +/- SD): Group 1: 3.58 +/- 1.07, Group 2: 3.86 +/- 1.12, Group 3: 1.20 +/- 0.67, and Group 4: 1.50 +/- 1.21 (P<0.001)]; [4 h VAS scores (mean +/- SD): Group 1: 2.55 +/- 1.26, Group 2: 2.87 +/- 1.14, Group 3: 1.66 +/- 1.06, and Group 4: 2.02 +/- 1.23 (P<0.001)]; [6 h VAS scores (mean +/- SD): Group 1: 2.50 +/- 0.91, Group 2: 2.53 +/- 1.14, Group 3: 1.66 +/- 1.06, and Group 4: 2.02 +/- 1.23 (P<0.001)]; [12 h VAS scores (mean +/- SD): Group 1: 3.24 +/- 1.2, Group 2: 3.49 +/- 1.14, Group 3: 2.83 +/- 0.98, and Group 4 : 2.99 +/- 1.36 (P<0.001)]; and [24 h VAS scores (mean +/- SD): Group 1: 3.75 +/- 0.99, Group 2: 4.01 +/- 0.91, Group 3: 3.61 +/- 1.34, and Group 4: 4.01 +/- 1.08 (P<0.001)]. Conclusion: Bupivacaine spraying reduces postoperative abdominal pain, while drain placement minimizes shoulder pain by reducing CO2 remaining under the diaphragm.