Gall Bladder Bed Infiltration Analgesia

• The time to the first request of analgesia[ Time Frame: postoperative, for 24 hours ]
  hours
• The intraoperative fentanyl requirements.[ Time Frame: intraoperative ]
  microgram
• postoperative pain score: VAS[ Time Frame: postoperative at 0, 2, 4, 8, 12, 16 and 24 hours ]
  visual analog score from 0-10, zero is no pain, 10 is the most imaginable pain,
• heart rate[ Time Frame: basal and intraoperatively every 30 minutes, then at 0, 2, 4, 8, 12, 16 and 24 hours post-operatively. ]
  beat/ minute
• mean blood pressure[ Time Frame: basal and intraoperatively every 30 minutes, then at 0, 2, 4, 8, 12, 16 and 24 hours post-operatively. ]
  mmHg
• incidence of vomiting[ Time Frame: postoperatively, during the first 24 hours ]
  number
• the sleep quality[ Time Frame: postoperatively, after the first night. ]
  through a score 0-2, where 0= good quite sleep, 1= fair sleep, 2= bad quality of sleep.
• Patient satisfaction regards analgesia:[ Time Frame: postoperative after 24 hour. ]
  using visual analog score from 0-10. zero = no satisfaction, 12= maximum satisfaction.
• Surgeon satisfaction regards the technique:[ Time Frame: postoperative within 1 hour. ]
  using visual analog score from 0-10. zero = no satisfaction, 10= maximum satisfaction.

Early postoperative pain is a common complaint after elective laparoscopic cholecystectomy. Persistent acute postoperative pain is the dominating complaint and the primary reason for a prolonged stay after this procedure. This pain can be superficial incisional wound pain (somatic), deep visceral pain and/or post-laparoscopy shoulder pain (referred somatic), all of which may require systemic analgesia. Hypothesis: Laparoscopic pain can be superficial incisional wound pain (somatic pain), deep visceral pain and/or post-laparoscopy shoulder pain (referred somatic pain), so the block must be periportal for incisional wound pain, intraperitoneal to decrease pain caused by pneumoperitoneum, and of the bladder bed to decrease the deep visceral pain. This combination can give the maximum analgesia after laparoscopic cholecystectomy.

• Drug: the infiltration group
  15-20 ml periportal, 50 ml in gallbladder bed, The rest (about 150 ml in 70 Kg patient) will be intraperitoneal
• Drug: the control group
  the 50 ml prepared for gallbladder bed infiltration will be replaced by saline.

• Active Comparator: the infiltration group
  a cocktail of 5 mg/Kg lidocaine normal saline in a volume of 3 ml/Kg 5 mcg/ml adrenaline. We will administrate 5 ml lidocaine at each port site before incision, then immediately after the creation of the pneumoperitoneum, the surgeon will spray 50-75 ml of the total solution on the upper surface of the liver under the right sub-diaphragmatic space and another 50-75ml over the parietal peritoneum. The Trendelenburg position will be maintained for 2 minutes. Then 50 ml will be infiltrated in the bladder bed and pedicle after clamping of the cystic duct and artery. Infiltration will be through a laparoscopic suction needle, diameter 0.9 /330 mm (Zhejiang, China).
• Placebo Comparator: the control group
  the same technique but the 50 ml for gallbladder infiltration will be replaced by saline.