Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 1 3 2015 10 03 67 71 EN Afshin Farhanchi Department of Anaesthesiology and Critical Care, Ekbatan Hospital, Hamedan University of Medical Sciences, Hamedan, Iran. Moigan Rahmani Department of Anesthesiology and Critical Care, Imam Khomeini Medical Center, Tehran University of Medical Sciences, Tehran, Iran. Ladan Moharamzadeh Department of Anesthesiology and Critical Care, Arash Hospital, Tehran University Medical Sciences, Tehran, Iran. Pooya Kalani Department of Anaesthesiology and Critical Care, Imam Reza Hospital, Hamedan University of Medical Sciences, Hamedan, Iran. 2015 10 03 2015 10 03 Background: Although  laparoscopic   cholecystectomy  is   associated  with less  post-operative  pain compared  to  open  cholecystectomy,  diffuse shoulder  and  abdominal  pain  is   one    of   the    main postoperative complications in  this technique. The  aim  of this study was  to  compare the abdominal and shoulder pain after laparoscopic cholecystectomy by  applying intra-abdominal  bupivacaine instillation versus the  trendelenburg position and valsalva maneuver. Methods: A double blind randomized clinical trial was  conducted in the university hospital. 120  patients aged 25-55 years were scheduled for  elective laparoscopic cholecystectomy and without any  history of previous surgery, pregnancy or acute abdomen were enrolled. Patients were allocated into 4 groups (each30 cases)Group 1 received just intra-peritoneal normal saline (NS). Group 2 patients who were placed intrendelenburg  position  plus valsalva maneuver  and  received intra-peritoneal  NS.  For   group 3,  intra- peritoneal bupivacaine instillation was  done. Patients in group 4 received intra-peritoneal bupivacaine as well as  were placed in  trendelenburg position plus valsalva maneuver. Post-operative pain severity using visual analog scale, analgesic requirement and nausea and vomiting were recorded in all patients. Results: Total mean pain score at 24 hours was  3.55±0.47 in group 1, 1.08 ±0.85 in group 2, 0.33  ±0.14  in group 3, and 0.20  ±0.59  in group 4 (P= 0.001). Mean total score of shoulder pain was  4.70  ±2.18  in group1, 1.23  ±0.11  in group 2, 1.18  ±0.11  in group 3, and 0.70  ±0.12  in group 4 (P= 0.001). Conclusion: Combined  intra-peritoneal   bupivacaine  with trendelenburg  positioning  and   valsalva maneuver   was  superior   to either one alone in decreasing pain severity after laparoscopic cholecystectomy.   https://aacc.tums.ac.ir/index.php/aacc/article/view/3 https://aacc.tums.ac.ir/index.php/aacc/article/download/3/227