الفهرس 
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Abstract
A symptomatic gallstone disease is one of the prevailing problems seen in clinical practice. Surgical removal of the gall bladder can be done either laparoscopic or open surgery. Laparoscopic cholecystectomy (LC) affords different accomplishment compared to open cholecystectomy, and it is the accepted gallstone treatment approach, as it contributes minimum bowel disturbance, culminating in hasty return to function and reduce the length of stay at the hospital.
Similar to all surgical procedures, patients have compelling postoperative pain; the patients experience severe abdominal and throat pain at the start of the postoperative period and seek for pain relief after laparoscopic surgery.
Different methods have been proposed to control pain after laparoscopy. The note of peritoneal inflammation after carbon dioxide, pneumoperitoneum, contributes to a legitimate framework for the practice of non-steroidal anti-inflammatory drugs (NSAIDs). Nonetheless, treatment of post laparoscopic pain with NSAID revenues questionable outcomes. Presently, the common treatment for acute postoperative pain is the practice of systemic opioids. Opioids are not apart from complications. Drowsiness, nausea, vomiting, urinary retention are all side effects of opioids. These side effects can preeminent to longer stay and deprived patient outcomes.
The purpose of this study is therefore to compare the analgesic effect of intraperitoneal instillation of levobupivacaine plus morphine hydrochloride versus levobupivacaine plus magnesium sulfate to provide
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effective postoperative pain relief in patients undergoing L.C. under general anesthesia.
In this study, 60 patients suffering from acute or chronic cholecystitis and scheduled for L.C were included and divided into 2 groups; group A (n= 30): Patients received 30 ml levobupivacaine (0.25%) plus 3 mg morphine hydrochloride intraperitoneal at the site of surgery in the bed of the gallbladder via the navel port with patient in a trendelenburg position (after peritoneal washing and suction). group B (n= 30): Patients received 30 ml levobupivacaine (0.25%) plus 50 mg/kg magnesium sulfate in the same pattern as in the A group.
The summary of our results:
All patients‘ characteristics (age and gender) were insignificantly different in both groups.
Intraoperative mean arterial blood pressure was insignificantly different in both groups at all time measurements.
Intraoperative heart rate was insignificantly different in both groups at all time measurements .
Intraoperative SpO2 was insignificantly different in both groups at all time measurements .
Postoperative mean arterial blood pressure was insignificantly different in both groups at all time measurements .
Postoperative heart rate was insignificantly different in both groups at all time measurements .
SpO2 was insignificantly different in group A than group B.
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VAS was significantly lower at 3, 4, 6 and 8 hours in group A than group B (P = 0.007, 0.001, <0.001 and 0.018). VAS was insignificantly different between both groups at 0.5h, 1h, 2h, 12h and 24h.
First time of rescue analgesia ranged between 0.5 and 8h with a mean value of 6.53 ± 3.63 h in group A, and ranged between 0.5 and 8h with a mean value of 3.76 ± 2.91 h in group B. First time of rescue analgesia was significantly prolonged in group A than group B (P <0.05).
Pruritus occurred in 8 (26.67%) patients at group A, no patients in group B. Pruritus was significantly higher in group A than group B (P <0.005).
PONV occurred in 8 (26.67%) patients in group A and 5 (16.67%) in group B. PONV was insignificantly different between both groups.
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Conclusion
Intraperitoneal instillation of combination of bupivacaine plus morphine hydrochloride is superior to bupivacaine plus magnesium sulfate to reduce the intensity and incidence of postoperative pain in patients undergoing laparoscopic cholecystectomy surgery.