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 .
Continuous Infusion of Interpleural Bupivacaine Maintains Effective Analgesia After Cholecystectomy
Twenty‐five patients who had undergone elective cholecystectomy were prospect ively r and omized to receive via an interpleural catheter either a continuous infusion of 0.25 % bupivacaine at 0.125 mL·kg−1·h−1 ( n = 13 ) or repeated bolus injections ( n = 22 ) of 0.5 % bupivacaine with epinephrine 1:200,000 at 0.4 mL/kg every sixth hour . Adequacy of pain relief was measured by the amount of patient‐controlled analgesia morphine  required postoperatively and by patient scores on a visual analog scale obtained every sixth hour . Two venous blood sample s for measurements of serum bupivacaine levels were obtained from patients in the continuous group at hours 6 and 24 ; four blood sample s were obtained from patients in the bolus group , both immediately before and 30 min after injections at hours 6 and 24 . Among the patients receiving the bolus injections , morphine was required 62 ± 15 ( SEM ) times over the 24-h study period with total morphine dosage averaging 30 ± 15 mg . Corresponding values for patients in the continuous group were 35 ± 10 times and 23 ± 5 mg of morphine . The difference was not , however , statistically significant , but when activity during the 2-h time periods immediately before reinjection ere examined , patients in the bolus group required and received significantly more morphine  than did those in the continuous group ( P<0.05 ) . Patients in the continuous group had visual analog scale scores that averaged 2.9 ± 0.6 over the 24-h study period . Patients within the bolus group had visual analog scale scores before and again 30 min after injection that averaged 5.8 ± 0.8 arid 1.8 ± 0.5 , respectively ( P<0.05 ) . Serum bupivacaine levels increased in both groups between the sixth and 24th hour measurements ; the average postinjection bupivacaine levels were significantly higher ( P<0.05 ) with intermittent injection than corresponding levels in the continuous infusion group . The bupivacaine level rose to 3.2 ± 0.4 μg/mL 30 min after the bolus injection at hour 24 . In summary , continuous interpleural infusion of 0.25 % bupivacaine  provides safer and more effective postoperative pain relief after cholecystectomy than does intermittent interpleural injection of 0.5 % bupivacaine with epinephrine every 6
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 .