Publication:

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

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.