COMPARATIVE STUDY OF SUBHEPATIC VERSUS DIFFUSE INTRAPERITONEAL INFILTRATION OF LOCAL ANAESTHESIA FOR POSTOPERATIVE PAIN CONTROL IN LAPAROSCOPIC CHOLECYSTECTOMY: A RANDOMISED CONTROLLED TRIAL

Abstract

Background: Postoperative pain following laparoscopic cholecystectomy (LC) remains a significant determinant of patient morbidity, analgesic consumption, and hospital stay. Intraperitoneal local anaesthetic (IPLA) instillation is widely employed, yet the optimal anatomical distribution — subhepatic (SH) versus diffuse intraperitoneal (DIP) infiltration — has not been definitively established in a sufficiently powered randomised trial. Aim: To compare the analgesic efficacy, postoperative opioid consumption, shoulder pain incidence, time to mobilisation, and duration of hospital stay between subhepatic and diffuse intraperitoneal bupivacaine infiltration in patients undergoing elective laparoscopic cholecystectomy. Methods: This prospective, double-blind, randomised controlled trial enrolled 100 ASA Class I–II adult patients undergoing elective LC under general anaesthesia, equally allocated to Group SH (n=50, subhepatic instillation of 30 mL 0.25% bupivacaine) and Group DIP (n=50, diffuse intraperitoneal instillation). VAS pain scores were recorded at 1, 4, 8, 12, and 24 hours postoperatively. The chi-square test, Mann-Whitney U test, and independent t-test were used for statistical analysis (p<0.05). Results: Severe pain (VAS ≥7) at 1 hour was significantly more frequent in Group SH at rest (46.9% vs. 18.0%; p=0.001) and on movement (65.3% vs. 30.0%; p<0.001). Shoulder pain at 1 hour was present in 34 (68.0%) Group SH patients versus 22 (44.0%) Group DIP patients (p=0.012). Rescue analgesia was required more frequently in Group SH (76.0% vs. 48.0%; p=0.003). Delayed ambulation (>8 hours) was significantly more common in Group SH (44.9% vs. 18.0%; p=0.003). Adverse events were comparable between groups. Conclusion: Diffuse intraperitoneal bupivacaine instillation provides superior early postoperative analgesia with significantly lower rates of severe pain, shoulder pain, rescue analgesia requirement, and delayed mobilisation compared to subhepatic instillation alone. Diffuse IPLA should be the preferred technique in laparoscopic cholecystectomy.