Intraperitoneal local anaesthetics via subphrenic catheter following laparoscopic cholecystectomy: pain relief and pulmonary function

Pain and pulmonary impairment continue to be major issues in the postoperative management of daycare laparoscopic cholecystectomy. 33 patients undergoing laparoscopic cholecystectomy were randomly assigned to one of two groups of postoperative pain management. The first group received prilocaine and bupivacaine via a subphrenic catheter inserted through a trocar incision at the end of laparoscopy. The second group received i.v. piritramid on request. Pain and alertness' were assessed by visual analogue scales, pulmonary function by bedside spirometry and arterial blood gas analysis. There was no difference in pain scoring between groups, but pain relief was significantly faster in Group 1. No differences were found between groups in impaired postoperative forced vital capacity and peak expiratory flow, but only Group 2 patients developed hypercarbia. It is concluded that postoperative pain relief via a subphrenic catheter is faster, equally effective and associated with greater alertness and no hypercarbia. Impaired pulmonary function cannot be improved when applying prilocaine and bupivacaine via the subphrenic catheter, instead of giving i.v. piritramid.