Pre-incision local infiltration with levobupivacaine reduces pain and analgesic consumption after laparoscopic cholecystectomy : A new device for day-case procedure

All over the World laparoscopic cholecystectomy is the treatment of choice for symptomatic cholelithiasis; use of local long lasting anesthetics reduces post-operative pain. Levobupivacaine is one of the most effective local anesthetics. The aim of our study is to test the effectiveness of local anesthetics comparing pre- versus post-operative trocar site's infiltration. 50 patients were enrolled in our study and 25 five patients were randomized into pre-I group (pre-incisional infiltration) and 25 into post-I group (post-operative infiltration); all the operations were performed with the same technique (Anglo-Saxon with 4 accesses) by 4 expert laparoscopic surgeons; our results showed different analgesic consumption between the 2 groups of patients; in the pre-I group the mean intravenous dose of Ketorolac post-operative used was 124 mg while in the post-I group was 339 mg: this difference was statistically significant.; the mean VAS was 10.7 in the post-I group while in the pre-I group was 5.1, also the i-VAS score's difference was statistically significant: in fact in the post-I group i-VAS was 8.8 while in the post-I group 14.8. Our study demonstrated that infiltration of the trocar site with long lasting local anesthetic is extremely effective for the treatment of post-operative pain after laparoscopic cholecystectomy; pre-incisional local infiltration seems to be better in term of pain perception and intravenous post-operative analgesic consumption.