Evaluation of Postoperative Analgesia with Intraperitoneal Instillation of 0.5% Inj Ropivacaine with 0.9% Normal Saline in Laparoscopic Cholecystectomy.

Abstract

Background: Laparoscopic cholecystectomy (LC) being one of the most commonly performed day care surgeries is still plagued by significant visceral pain for which multimodal analgesics have been tried. Intraperitoneal administration of local anaesthetics is one such modality. Ropivacaine when used intraperitoneally provides profound and prolonged analgesia.

OBJECTIVES: To study the analgesic efficacy, duration of analgesia and side effects, of intraperitoneal instillation of 0.5% ropivacaine in Laparoscopic Cholecystectomy.

STUDY DESIGN: Randomised control study.

PARTICIPANTS: 100 ASA II/III patients of either gender, aged 20-60 years undergoing LC.

METHODS: Participants were randomly allocated in two groups: Group A (n= 50) received 30 ml ropivacaine 0.5% and Group B (n= 50) received 30 ml normal saline intraperitoneally. Postoperative pain assessment was done using visual analogue scale (VAS) for 24 hrs. Intravenous diclofenac 75mg was given at VAS ≥4. Time to first request of analgesia, total number of rescue analgesics in 24 hours at VAS ≥4, incidence of postoperative shoulder pain as well as adverse effects were noted.

RESULTS: Low VAS scores were observed in group A at all times compared with group B (p< 0.05) except at 24 hrs, where the difference was not significant (p=0.124) . Time to rescue analgesia was longer in group A than group B, (p=0.003) . Total rescue analgesia consumption was lower in group A than group B, (p< 0.05) . Postoperative shoulder pain and side effects among the 2 groups at all times were statistically not-significant (p>0.05)

CONCLUSIONS: Intraperitoneal instillation of 0.5%Ropivacaine provides an effective and protracted analgesia in patients undergoing laparoscopic cholecystectomy.

IMPLICATIONS: Safe and prolonged control of postoperative pain in laparoscopic cholecystectomy is produced by intraperitoneal ropivacaine.