Postoperative pain relief after laparoscopic cholecystectomy: a comparison between intraperitoneal instillation of ropivacaine and bupivacaine

Dhiraj Tambade; Sandeep Mutha; Deepak Phalgune; Ganesh Ghongate

doi:10.18203/2349-3933.ijam20251935

Authors

Dhiraj Tambade Department of Anaesthesiology, Poona Hospital & Research Centre, Pune, Maharashtra, India
Sandeep Mutha Department of Anaesthesiology, Poona Hospital & Research Centre, Pune, Maharashtra, India
Deepak Phalgune Department of Research, Poona Hospital & Research Centre, Pune, Maharashtra, India
Ganesh Ghongate Department of Anaesthesiology, Poona Hospital & Research Centre, Pune, Maharashtra, India

DOI:

https://doi.org/10.18203/2349-3933.ijam20251935

Keywords:

Bupivacaine, Intraperitoneal instillation, Laparoscopic cholecystectomy, Ropivacaine, Visual analogue scale score

Abstract

Background: Although some studies have reported a significant reduction in postoperative pain after the use of intraperitoneal local anaesthetic in laparoscopic cholecystectomy (LC), others have reported no benefit or reduction in analgesic requirement. The present randomized controlled study compares the analgesic efficacy of intraperitoneally instilled local anaesthetic ropivacaine and bupivacaine after LC.

Methods: Sixty patients aged between 18 and 65 years, scheduled to undergo LC and American Society of Anesthesiologist grades I-II were randomly divided into two groups by computer-generated tables. Group A patients received an intraperitoneal instillation of 20 ml of 0.50% ropivacaine and group B patients received an intraperitoneal instillation of 20 ml of 0.50% bupivacaine after completion of the surgery. The primary objective was to compare the presence of post-operative shoulder-tip pain, whereas the secondary objectives were to compare adverse effects and hemodynamic changes. The visual analogue scale (VAS) score and hemodynamic parameters were recorded up to 24 hours postoperatively.

Results: The mean VAS score, heart rate and systolic blood pressure were significantly higher in Group B than in Group A (p value=0.001). The mean diastolic blood pressure was comparable between the two groups (p-value=0.215). The requirement for rescue analgesia was significantly higher in Group B than in Group A (p-value=0.001). The incidence of nausea and shoulder tip pain were comparable between the two groups (p values=0.612).

Conclusions: Intraperitoneal instillation of ropivacaine provides an excellent alternative for intraperitoneal analgesia in laparoscopic cholecystectomy cases.

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