The Comparisons of Intra-Peritoneal Bupivacaine Instillation Versus Trendelenburg Position and Valsalva Maneuver on the Laparoscopic Cholecystectomy-Induced Abdominal and Shoulder Pain

Background: although laparoscopic cholecystectomy is associated with less post-operative pain compared to open cholecystectomy, diffuse shoulder and abdominal pain is one of the main postoperative complications in this technique. the aim of this study was to compare the abdominal and shoulder pain after laparoscopic cholecystectomy by applying intra-abdominal bupivacaine instillation versus the trendelenburg position and valsalva maneuver. methods: a double blind randomized clinical trial was conducted in the university hospital. 120 patients aged 25-55 years were scheduled for elective laparoscopic cholecystectomy and without any history of previous surgery, pregnancy or acute abdomen were enrolled. patients were allocated into 4 groups (each 30 cases). group 1 received just intra-peritoneal normal saline (ns). group 2 patients who were placed in trendelenburg position plus valsalva maneuver and received intra-peritoneal ns. for group 3, intra-peritoneal bupivacaine instillation was done. patients in group 4 received intra-peritoneal bupivacaine as well as were placed in trendelenburg position plus valsalva maneuver. post-operative pain severity using visual analog scale, analgesic requirement and nausea and vomiting were recorded in all patients. results: total mean pain score at 24 hours was 3.55±0.47 in group 1, 1.08 ±0.85 in group 2, 0.33 ±0.14 in group 3, and 0.20 ±0.59 in group 4 (p= 0.001). mean total score of shoulder pain was 4.70 ±2.18 in group 1, 1.23 ±0.11 in group 2, 1.18 ±0.11 in group 3, and 0.70 ±0.12 in group 4 (p= 0.001). conclusion: combined intra-peritoneal bupivacaine with trendelenburg positioning and valsalva maneuver was superior to either one alone in decreasing pain severity after laparoscopic cholecystectomy.