SUPERIOR SOMATIC PAIN RELIEF AND IMPROVED VISCERAL PAIN CONTROL IS ACHIEVED USING PRE-EMPTIVE ANALGESIA FOR LAPAROSCOPIC CHOLECYSTECTOMY: A RANDOMIZED CONTROLLED TRIAL

Background: laparoscopic cholecystectomy, although is less invasive than open surgery, is not completely pain free. the use of local anaesthesia to relieve pain following this procedure is a common practice. however, it remains debatable whether a pre- or post-operative drug administration is more effective. here, we investigated the role of preemptive local anaesthetic infiltration given pre- or post-incisional, in relieving the pain during laparoscopic surgery. methodology: a randomized controlled trial was conducted with 96 patients receiving 0.5% bupivacaine 100mg. group a (n=48) received post-incisional skin infiltration whilst group b (n=48) received pre-incisional infiltration. incisional (somatic) and intra-abdominal (visceral) pain was assessed using visual analog scale (vas) at day 0, day 1 and day 7 post-operative days.result: baseline characteristics between the two groups were similar. incisional pain was lower in group b as compared to group a at day 0 (p=0.03) and day 1 (p<0.01). intra-abdominal pain was also lower in group b at day 0 and day 1 (p= 0.04). vas score was similar at day 7 although analgesia requirement is higher in group a (p>0.05).conclusion: administration of pre-incisional local anaesthesia offers better pre-emptive pain relief measure than post-incisional administration by reducing somatic and visceral pain in laparoscopic gall bladder surgery.