CLINICAL EFFECTIVENESS OF PERIOPERATIVE LOCAL BUPIVACAINE IN MULTIMODAL ANALGESIA IN ERAS PROTOCOL: A PROSPECTIVE COMPARATIVE STUDY
ANTONIO MIHAI ISTRATE 1,2#, TUDOR MIHAI BĂDESCU 3#, DRAGOȘ ȘERBAN 2,4*, LAURENȚIU SIMION 4, CĂTĂLIN CICERONE GRIGORESCU 5, ANCA ZGURA 4, FLORIN BOBIRCĂ 4, BOGDAN MIHAI CRISTEA 4, CORNELIU TUDOR 2,4, ALEXANDRU DARIUS DRAGOMIR ȘERBOIU 4, ALEXANDRA DIMIENESCU 1,2, ANA MARIA DASCĂLU ⁴
¹ Doctoral School, “Carol Davila” University of Medicine and Pharmacy Bucharest, Romania
2 Fourth Surgery Department, Emergency University Hospital Bucharest
3 Faculty of Medicine, “Lucian Blaga” University of Sibiu, 550169, Sibiu, Romania;
4 Faculty of Medicine “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
5 Faculty of Medicine, “Vasile Goldis” Western University of Arad, 310025, Arad, Romania
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Conventional bupivacaine hydrochloride is widely used in multimodal analgesia because of its prolonged local anesthetic effect, but its role in Enhanced Recovery After Surgery (ERAS) protocols for emergency laparoscopic cholecystectomy remains unclear. This prospective comparative study evaluated the efficacy and safety of perioperative bupivacaine hydrochloride within an ERAS protocol in 130 consecutive patients undergoing emergency laparoscopic cholecystectomy for acute calculous cholecystitis. Sixty-three patients received perioperative bupivacaine hydrochloride by port-site infiltration and intraperitoneal instillation, while sixty-seven received standard perioperative analgesia. Outcomes included postoperative pain, rescue analgesic use, recovery parameters, and adverse events. Compared with controls, the bupivacaine group had significantly lower pain scores during the first 12 postoperative hours, reduced opioid and non-opioid rescue analgesic requirements, earlier mobilization, faster oral intake, shorter hospital stay, and less postoperative nausea and vomiting (all p < 0.05). No local anesthetic systemic toxicity or major drug-related complications occurred. Conventional bupivacaine hydrochloride is a safe and effective component of ERAS-based multimodal analgesia for emergency laparoscopic cholecystectomy, improving early recovery while reducing postoperative pain and opioid requirements.
