This approach has been design ed to provide adequate analgesia while minimizing exposure to adverse events
Background : Laparoscopic cholecystectomy has advantages over the open procedure for postoperative pain .
However , a systematic review of postoperative pain management in this procedure has not been conducted .
Intraperitoneal Versus Interpleural Morphine or Bupivacaine for Pain after Laparoscopic Cholecystectomy
Background Opioids can produce peripheral analgesic effects by activation of opioid receptors on sensory nerves . This study was design ed ( 1 ) to examine a novel route of opioid administration , the intraperitoneal injection ; ( 2 ) to compare this to interpleural application , and ( 3 ) to compare opioid with local anesthetic effects under both conditions . Methods At the end of laparoscopic cholecystectomy , 110 patients received the following injections in a double‐blind , r and omized manner : Group 1 ( n = 18 ) was given intraperitoneal morphine ( 1 mg in 20 ml saline ) and 20 ml intravenous saline . Group 2 ( n = 17 ) received intraperitoneal saline and 1 mg intravenous morphine . Group 3 ( n = 15 ) received 20 ml 0.25 % intraperitoneal bupivacaine and intravenous saline . Group 4 ( n = 20 ) received interpleural morphine ( 1.5 mg in 30 ml saline ) and 30 ml intravenous saline . Group 5 ( n = 20 ) received interpleural saline and 1.5 mg intravenous morphine . Group 6 ( n = 20 ) received 30 ml 0.25 % interpleural bupivacaine and intravenous saline .  Postoperative pain was assessed using a visual analog scale , a numeric rating scale , and the McGill pain question naire . Pain localization , supplemental analgesic consumption , vital signs , and side effects were recorded for 24 h. Results Neither intraperitoneal nor interpleural morphine produced significant analgesia after laparoscopic cholecystectomy ( P > 0.05 , Kruskal‐Wallis test ) , whereas interpleural bupivacaine was effective ( P < 0.05 , Kruskal‐Wallis test , up to 6 h postoperatively ) but not intraperitoneal bupivacaine ( P > 0.05 , Kruskal‐Wallis test ) . Shoulder pain was not prevalent in the majority of patients during the first 6 h. By 24 h , about half of the patients complained of shoulder pain , which was rated “ low ” by about one‐third of all patients . No significant side effects occurred . Conclusions Interpleural bupivacaine ( 0.25 % ) produces analgesia after laparoscopic cholecystectomy . We attribute the lack of effect of intraperitoneal injections to the small dose and to a rapid dilution within the peritoneal cavity . The fact that interpleural morphine ( 0.005 % ) is ineffective may be due to an intact perineurial barrier in the noninflamed pleural cavity , which restricts the transperineurial passage of morphine to opioid receptors on intercostal nerves
This approach has been design ed to provide adequate analgesia while minimizing exposure to adverse events
Background : Laparoscopic cholecystectomy has advantages over the open procedure for postoperative pain .
However , a systematic review of postoperative pain management in this procedure has not been conducted .