A Comparative Study of Intraperitoneal Ropivacaine and Bupivacaine for Postoperative Analgesia in Laparoscopic Cholecystectomy

Abstract

BACKGROUND Every surgical procedure inflicts pain during the procedure which also continues in the post-operative period as post-operative pain. Intraperitoneal instillation of local anaesthetics in laparoscopic cholecystectomy has been used to reduce postoperative pain and to decrease the need for postoperative analgesics. We wanted to compare intraperitoneal instillation of bupivacaine and ropivacaine for postoperative analgesia in patients undergoing laparoscopic cholecystectomy. METHODS After obtaining ethical committee's clearance and informed consent, sixty patients, aged 20-60 years, of either gender, and American Society of Anaesthesiologists physical status I to II scheduled for laparoscopic cholecystectomy were included and categorized into two groups (n=30). Group B patients received 20 mL of 0.5% bupivacaine intraperitoneally after cholecystectomy and Group R patients received 20 mL of 0.75% ropivacaine intraperitoneally after cholecystectomy. Mean duration of postoperative analgesia and number of doses of rescue analgesic required were observed. Patients were assessed at 0, 2, 4, 8, 12, 18 and 24 hours postoperatively with respect to quality of analgesia (VAS), hemodynamic parameters and side effects. RESULTS Mean Time for first rescue analgesic requirement was 148.04 ± 53.47 min in group B and 295.38 ± 74.15 in group R and the difference was statistically significant (p=0.0001). In group R 17 (56.6%) patients did not require any rescue analgesic throughout the study period as compared to 8 (26.6%) patients in group B. The difference between the two groups was statistically significant. (p=0.019). A lower VAS score was observed in group R as compared to group B, with statistically significant difference at 2, 4 and 8 hours respectively. (p= 0.001, 0.003 and 0.032). CONCLUSIONS 0.75% ropivacaine is a better alternative to 0.5% bupivacaine when given intraperitoneally for management of postoperative pain in patients undergoing laparoscopic cholecystectomy under general anaesthesia as it prolongs the duration of analgesia, provides a better quality of analgesia till 8 hours postoperatively, with lesser demand and requirement of rescue analgesic in the postoperative period, and has lesser side effects.

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