Evaluation of intraperitoneal instillation of levobupivacaine versus ultrasound guided rectus sheath block for post-operative pain relief following laparoscopic cholecystectomy

Background: Laparoscopic cholecystectomy (LC) is not a painless process, with the most acute pain occurring on the day of surgery and the next day. Postoperative pain management methods include intraperitoneal instillation of local anaesthetics and rectus sheath block (RSB), both of which may give excellent pain reduction. Objectives: The aim of this study was to evaluate the efficacy of intraperitoneal instillation versus rectus sheath block using levobupivacaine for postoperative pain relief after laparoscopic cholecystectomy. Patients and methods: The study was a prospective randomized double-blind study. Patients were randomized into two groups using a closed envelope technique in sequentially numbered opaque envelopes that was opened by an anesthesiologist not involved in the study. The study was conducted on 50 patients, 25 each for each group. Group I received intraperitoneal instillation of 40 ml 0.25% levobupivacaine. Group II (Rectus sheath block) received bilateral RSB with 40 ml of 0.25% levobupivacaine (20 ml on each side). Results: There was high statistical significant difference between groups as regard VAS. There was high statistical significant difference between groups as regards patient satisfaction, which was more increased among rectus sheath group. Conclusion: U/S-guided rectus sheath block is effective as analgesic technique as intraperitoneal instillation of levobupivacaine led to more patient satisfaction, lower postoperative pain and lower amount of anaesthetic consumption. Both techniques are simple, safe, and without adverse effects. This study favors the administration of rectus sheath block pre-emptively for postoperative pain relief after laparoscopic cholecystectomy.