POSTOPERATIVE PAIN RELIEF FOLLOWING LAPAROSCOPIC CHOLECYSTECTOMY: BUPIVACAINE INFILTRATION VERSUS INTRAVENOUS TRAMADOL - A RANDOMIZED CONTROLLED STUDY

Aim:To compare the efficacy and safety of local infiltration of bupivacaine versus intravenous tramadol for postoperative pain relief in patients undergoing laparoscopic cholecystectomy.

Material and methods: In this prospective, randomized controlled trial, 120 ASA I-II patients undergoing elective laparoscopic cholecystectomy were allocated into two equal groups. Group B received 0.25% bupivacaine (2-3 mL per port site) infiltrated locally at trocar sites, while Group T received 100 mg intravenous tramadol at the end of surgery. Pain was evaluated using the Visual Analog Scale (VAS) at 2, 4, 6, 8, 10, and 24 hours postoperatively. Intravenous paracetamol (1 g) was given as rescue analgesia if VAS 4. Adverse effects and hemodynamic parameters were monitored. Data were analysed using SPSS V20, with p < 0.05 considered statistically significant.

Results: The two groups were comparable in demographic and clinical variables (p > 0.05). Group B (bupivacaine) showed significantly lower VAS scores at all time points compared to Group T (tramadol). At 10 hours postoperatively, the mean VAS score was 1.82 0.60 in Group B versus 4.10 0.82 in Group T (p = 0.0001). Group T experienced a higher incidence of nausea (25% vs. 6.7%, p = 0.01), vomiting (16.7% vs. 3.3%, p = 0.02), and sedation (20% vs. 0%, p = 0.0005). Both groups maintained stable heart rate and mean arterial pressure throughout the postoperative period, with no significant cardiovascular complications.

Conclusion: Bupivacaine infiltration is more effective than intravenous tramadol for postoperative pain relief following laparoscopic cholecystectomy. It offers superior analgesia, fewer adverse effects, and better overall patient comfort, making it a safer and preferred option for early postoperative pain management.