The effect of intraperitoneal and incisional bupivacaine or levobupivacaine administrations on postoperative tramadol hci consumption in laparoscopic cholecystectomy

We aimed to find out the effect of bupivacaine or levobupivacaine that is administered via intra-peritoneal and intra-incisional routes to the patients undergoing elective laparoscopic cholecystectomy surgery on the postoperative consumption of tramadol HCI, which is given with patient-controlled analgesia (PCA) device.For this purpose, we randomly divided 60 patients into 3 groups; the group K was named control group, the group B was called bupivacaine group and the group L was defined as levobupivacaine group. At the end of the surgical procedure, 80 ml of 0,9% NaCl solution was sprayed on the gallbladder bed and the right and left subdiaphragmatic areas, in that order, and then 20 ml of the same solution was infiltrated into the port entry sites, 5 ml for each site. In the group B, bupivacaine (20 ml of 5 mg/ml drug was diluted in 80 ml of 0,9% NaCl; a total of 100 ml solution) and in the group L, levobupivacaine (20 ml of 5 mg/ml drug was diluted in 80 ml of 0,9% NaCl; a total of 100 ml solution) was administered to the areas mentioned above. After extubation, the patients were admitted in the recovery room and the time of admission was set to be the hour 0. The first VAS assessment was done. After the admission inthe recovery room, tramadol HCI was given using PCA device with the settings of 50 mg loading dose, 5 mg/hour basal infusion, 20 mg bolus dose, 30 minutes lockout interval and 200 mg for 4-hour limit. Resting and coughing VAS values of the patients were questioned at 0 and 30 minutes and 2, 4, 8, 12 and 24. hours; and total amounts of analgesic used within 24 hours were recorded.In conclusion, we judged that in the laparoscopic cholecystectomy, administration of either bupivacaine or levobupivacaine via intra-peritoneal and -incisional routes reduced the amount of tramadol HCI used in the postoperative period and that it could be an effective approach for pain management.Key Words: Laparoscopic cholecystectomy, Bupivacaine, Levobupivacaine, Postoperative pain, Tramadol HCI