Postoperative pain relief after laparoscopic cholecystectomy: a placebo-controlled double-blind randomized trial of preincisional infiltration and intraperitoneal instillation of levobupivacaine 0.25%

Surg Endosc. 2005 Nov;19(11):1503-6. doi: 10.1007/s00464-005-3002-4. Epub 2005 Oct 3.


Background: The aim of this study was to test the use of preincisional and intraperitoneal levobupivacaine (L-B) 0.25% in laparoscopic cholecystectomies for postoperative analgesia.

Methods: A total of 108 patients under general anesthesia were randomly assigned to receive preincisional local infiltration of 20 ml solution and intraperitoneal instillation of another 20 ml solution. Group A received for local infiltration and intraperitoneal instillation normal saline (NS). Group B received for local infiltration L-B 0.25% and for intraperitoneal instillation NS. Group C received for local infiltration NS and for intraperitoneal instillation L-B 0.25%. Group D received both for local infiltration and intraperitoneal instillation L-B 0.25%. Abdominal and right shoulder pain were recorded for 24 h postoperatively.

Results: The pain scores were lower in group D than in the other groups during rest, cough, and movement (p < 0.05). Rescue analgesic treatment was significantly lower in patients of group D (35%) as compared with that of group A (84%) (p < 0.05). The incidence of right shoulder pain was significantly lower in groups C (22%) and D (18%) than in any of the other groups (p < 0.05).

Conclusions: The combination of preincisional local infiltration and intraperitoneal instillation of L-B 0.25% shows an advantage for postoperative analgesia after laparoscopic cholecystectomy.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Aged
  • Anesthetics, Local / administration & dosage*
  • Bupivacaine / administration & dosage
  • Bupivacaine / analogs & derivatives
  • Cholecystectomy, Laparoscopic / adverse effects*
  • Double-Blind Method
  • Female
  • Humans
  • Instillation, Drug
  • Levobupivacaine
  • Male
  • Middle Aged
  • Pain, Postoperative / etiology*
  • Pain, Postoperative / prevention & control*
  • Preoperative Care*


  • Anesthetics, Local
  • Levobupivacaine
  • Bupivacaine