A comparative study of impact on Post-operative analgesia with intraperitoneal irrigation of high volume low concentration bupivacaine plus hydrocortisone vs bupivacaine alone in patients undergoing elective cholecystectomy.

Laparoscopic cholecystectomy has become a preferred modality of treatment in gall bladder surgeries. It is the gold standard for the treatment of symptomatic cholelithiasis and chronic cholecystitis. Pain is a frequent complaint following laparoscopic cholecystectomy(LC). Pain in LC can be divided into components such as parietal ,viscera and shoulder pain.Visceral pain accounts for most of the discomfort experienced in the early post operative period.Intensity quickly decreases after the first 24hrs post operatively.Shoulder tip pain dominates as visceral pain decreases. The surgical stress and insufflation of abdomen with CO2 causing rapid distention of the peritoneum may result in tearing of blood vessels ,traumatic traction of the nerves and release of inflammator meiators   causing pain.Pneumoperitoneum with CO2 is thought to cause   phrenic nerve irritation secondarily causing referred shoulder tip pain. Various drugs and methods have been studied to effectively  counter these undesirable effect . Local anaesthetics have been observed  to be effective in providing post operative analgesia in patients undergoing laparoscopic cholecystectomy .Some studies have observed that     intraperitoneal Bupivacaine does not reduce pain after laparoscopic cholecystectomy , but these studies used high concentration low volume bupivacaine intraperitoneally. It has   been demonstrated that use of  bupivacaine as low concentration high volume intraperitoneal irrigation,intraoperatively  is effective in prolonging the duration of analgesia reduces post operative rescue analgesic requirement in the initial 24 hr without significant postoperative adverse effects.