Abstract
Introduction: The most common complaint in patients undergoing laparoscopic cholecystectomy is pain, especially in the abdomen, back, and shoulder regions. Relieving of pain after laparoscopic cholecystectomy is one of the most important concerns in postoperative care.
Objectives: In this study, we aimed to determine the effect of intraperitoneal Ketamine, lidocaine, and normal saline irrigation in patients undergoing laparoscopic cholecystectomy.
Patients and Methods: In a randomized, triple-blinded clinical trial, 66 patients were equally assigned into three groups, and intraperitoneal irrigation was done in the first group with lidocaine+ normal saline, the second group with ketamine + normal saline, and the third group with normal saline alone. The intensity and duration of the patient’s pain in the abdomen and shoulder area, as well as the need for analgesics at intervals of 6, 12, 18, and 24 hours during the post-surgery period, were evaluated using the standard visual analogue scale (VAS) pain measurement criterion.
Results: There were no significant differences between the three groups in terms of disease history, age and surgery duration, smoking, and gender. The overall intensity of shoulder pain was not different in the three groups (P=0.141, F=2.02). The overall amount of abdominal pain was not different in the three groups. (P=.078, F=2.663). Patients in whom intraperitoneal irritation was done by normal saline experienced less abdominal pain (regardless of time) than the other two groups.
Conclusion: Adding ketamine or lidocaine to normal saline for intraperitoneal irrigation has no any greater effect than normal saline alone in reducing pain, duration, and frequency of need for analgesics after surgery. With due attention to the relatively better effect of normal saline and lower cost and complications, it is recommended to irrigate the surgical bed, superior surface of the liver, and under the right hemi diaphragm with normal saline.
Trial registration: The trial protocol was approved in the Iranian registry of clinical trials (#IRCT 20151020024625N6; https://irct.behdasht.gov.ir/trial/29644, ethical code; IR.SEMUMS.REC.1395.94).