Post-operative Pain Relief in Laparoscopic Cholecystectomy

Brief Summary

compare the analgesic efficacy of the combination of bupivacaine and morphine, bupivacaine and fentanyl and bupivacaine and ketamine in alleviating post operative pain following laparoscopic cholecystectomy.

Intervention / Treatment

At the end of the procedure, all the subjects will be randomly allocated to groups using computer-generated random numbers. Each group of 30 subjects, that is, Group A (placebo): instillation of bupivacaine alone: Bupivacaine 25 ml (0.25%) after surgery completion; Group B : Instillation of bupivacaine and morphine: Bupivacaine 25 ml (0.25%) + Morphine (3.0 mg) Group C : Instillation of bupivacaine and fentanyl: Bupivacaine25 ml (0.25%) + fentanyl (30.0 Mc) Group D : Instillation of bupivacaine and Ketamine: Bupivacaine25 ml (0.25%) + ketamine (0.5 mg/kg).
  • Bupivacaine (DRUG)
    Bupivacaine 25 ml (0.25%)
  • Morphine (DRUG)
    Morphine (3.0 mg)
  • Fentanyl (DRUG)
    fentanyl (30.0 Mc)
  • Ketamine: (DRUG)
    ketamine (0.5 mg/kg).

Condition or Disease

  • Postoperative Pain

Phase

  • Not Applicable
  • Study Design

    Study type: INTERVENTIONAL
    Status: Unknown status
    Study results: No Results Available
    Age: 22 Years to 60 Years
    Enrollment: 120 (ESTIMATED)
    Funded by: Other
    Allocation: Randomized
    Primary Purpose: Treatment

    Masking

    TRIPLE:
    • Participant
    • Care Provider
    • Investigator

    Clinical Trial Dates

    Start date: Jan 01, 2018 ESTIMATED
    Primary Completion: Dec 01, 2018 ESTIMATED
    Completion Date: Mar 01, 2019 ESTIMATED
    Study First Posted: Nov 28, 2017 ACTUAL
    Results First Posted: Aug 31, 2020
    Last Updated: Nov 27, 2017

    Sponsors / Collaborators

    Lead Sponsor: Assiut University
    Responsible Party: N/A

    Laparoscopic cholecystectomy is comparatively advantageous over open cholecystectomy in pain management with shorter duration of hospital stays. Pain management is medically pertinent for optimal care in surgical patients. Although development and advancement in understanding of the patho-physiology of pain, analgesics, pharmacology and the development of better effective techniques for post-operative pain control, patients still continue to experience considerable discomfort.

    Laparotomy results in parietal pain, whereas laparoscopy has a visceral component, a somatic component and shoulder pain secondary to diaphragmatic irritation because of CO2 pneumo-peritoneum. Postoperative pain associated with laparoscopic cholecystectomy, although less severe and of shorter duration than that after open cholecystectomy, is still a source of marked discomfort and surgical stress. The degree of the pain after laparoscopic procedures has multifactorial influence including the volume of residual gas, type of gas used for pneumo-peritoneum, pressure created by the pneumo-peritoneum and insufflated gas temperature.

    Local anesthetic infiltration of the incision sites decreases postoperative opiate requirement and improves subjective pain scores but does eliminate the pain.

    Earlier scientists have also reported several beneficial effects of the intra-peritoneal application of bupivacaine with morphine on postoperative pain management after laparoscopic cholecystectomy.

    Participant Groups

    • instillation of bupivacaine alone: Bupivacaine 25 ml (0.25%) after surgery completion

    • Instillation of bupivacaine and morphine: Bupivacaine 25 ml (0.25%) + Morphine (3.0 mg)

    • Instillation of bupivacaine and fentanyl: Bupivacaine25 ml (0.25%) + fentanyl (30.0 Mc)

    • Instillation of bupivacaine and Ketamine: Bupivacaine25 ml (0.25%) + ketamine (0.5 mg/kg).

    Eligibility Criteria

    Sex: All
    Minimum Age: 22
    Maximum Age: 60
    Age Groups: Adult
    Healthy Volunteers: Yes

    Inclusion Criteria:

    * American Society of Anesthesiologists (ASA) classification I and II
    * scheduled for elective laparoscopic cholecystectomy
    * under a standardized general anesthesia technique.

    Exclusion Criteria:

    * uncooperative, unwilling,
    * history of anaphylaxis to local anesthetics and/or opioids and the drugs to be used,
    * history of drug abuse,
    * anmorbidly obese patients,
    * ASA classification III, IV, V
    * d patients having any other significant co-morbidities
    * any other with psychiatric disease
    * pregnant women

    Primary Outcomes
    • All subjects will be familiar with the visual analogue scale of pain (VAS) score preoperatively and will be instructed in detail on its use as a tool for measuring postoperative pain The pain VAS is a continuous scale comprised of a horizontal (HVAS) or vertical (VVAS) line, usually 10 centimeters (100 mm) in length, anchored by 2 verbal descriptors, one for each symptom extreme . A higher score indicates greater pain intensity. Based on the distribution of pain VAS scores in postsurgical patients (knee replacement, hysterectomy, or laparoscopic myomectomy) who described their postoperative pain intensity as none, mild, moderate, or severe, the following cut points on the pain VAS have been recommended: no pain (0-4 mm), mild pain (5-44 mm), moderate pain (45-74 mm), and severe pain (75- 100 mm) .

    More Details

    NCT Number: NCT03355716
    Other IDs: post-oprative pain relief
    Study URL: https://clinicaltrials.gov/study/NCT03355716
    Last updated: Sep 29, 2023