Pain Management of Emergency Laparoscopic Cholecystectomy in Patients With Acute Cholecystitis
Condition: Abdominal Pain; Shoulder Pain; Satisfaction; Complication
MeSH terms: Shoulder Pain; Cholecystitis; Acalculous Cholecystitis; Cholecystitis, Acute; Abdominal Pain
Study type: Observational [Patient Registry]

Summary: 
      Patients diagnosed with acute cholecystitis benefit from emergency laparoscopic
      cholecystectomy (LC). Patients who had emergency LC showed improvement in quality of life in
      one month compared to those treated. Delayed LC (after the acute cholecystitis has passed)
      and less time to recover from work. This strategy reduces the risk of repeated referrals with
      more pain or pancreatitis. There are many studies on the efficacy of intraoperative
      intraperitoneal bupivacaine(IPBV) with elective LC on pain of IPBV. However, the prospective
      study of reducing the postoperative pain of emergency LC - IPBV is very few. This study will
      be conducted to evaluate the efficacy of IPBV in patients with emergency LC.
    

Detailed description: 
      Patients to be included in the study will be selected from the group between 18 and 70 years
      of age who apply to general surgery and emergency policlinics, depending on patient approval.
      All patients will be informed about the operation and the procedures to be performed.
      Patients who accepted to participate in the study will be included in the study and
      randomization will be performed by randomly selected patients and two groups. The study will
      be carried out by 2 surgeons with 5 years of laparoscopic cholecystectomy (LC).Adult patients
      presenting with acute cholecystitis treated by emergency surgeons by one of two surgeons will
      be included in the study. These two surgeons will be responsible for the participant records.
      1.hepatobiliary ultrasound-confirmed acute cholecystitis diagnosis, 2. Patients undergoing
      elective laparoscopic cholecystectomy (el-LC) will not be included in the study. Patients
      converted into an open procedure will be excluded from the study. Patients will be divided
      into two groups. In Group A, intravenous 1 gr paracetamol via will be applied in 30 minutes
      after waking up.In Group B, immediately after the introduction of intraoperative laparoscopic
      trocars, 480 ml of saline + 20 ml of 5% bupivacaine solution will be washed in the
      subdiaphragmatic area, gallbladder region and the entire abdomen. In both groups, standard
      laparoscopic cholecystectomy will be performed. In both groups, nasogastric tube will be
      inserted at the end of the operation after intubation. , CRP(C-reactive protein) levels,
      ALT(Alanine Aminotransferase) , AST(Aspartate Aminotransferase),
      GGT(Gamma-Glutamyltransferase), total bilirubin, direct bilirubin values will be recorded.
      Pulse, heart rate, systolic and diastolic pressures, Oxygen saturation (with pulse) during
      surgery will be recorded in both groups. Post-operative VAS(Visual analogue score) and
      VRS(Verbal Rating Scales) pain scores will be performed. VAS 0-10 cm and VRS (no pain in
      cough (score = 0); pain in cough, not in deep breathing (score = 1); resting (score = 2),
      pain at rest, mild (score = 3); pain at rest, severe (score = 4)) will be evaluated as.
    

Observational model: Other
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        Patient aged 18-70 years diagnosed with ASA I, II and III acute cholecystitis