A Prospective Randomized Study of Intraperitoneal Instillation of Ropivacaine Versus Bupivacaine in Reduction of Post Operative Pain After Laparoscopic Cholecystectomy

Bimaljot Singh, MS, Ashwani Kumar, MS, Anand Munghate, MS. GOVERNMENT MEDICAL COLLEGE , PATIALA

Introduction: The study was conducted to compare the efficacy of intraperitoneal instillation of Ropivacaine versus Bupivacaine for post operative pain relief after laparoscopic cholecystectomy and to compare the analgesic requirement and overall morbidity in patients with either of two interventions.

Material and Method :    This prospective study was conducted in the Department of General Surgery, Govt. Medical College & Rajindra Hospital Patiala. 60 patients with symptomatic gall stones disease undergoing laparoscopic cholecystectomy were included with equal distribution either Group A (n=30 patients) received 0.5% of 30ml (150mg) of ropivacaine instillation at gall bladder bed ; Group B(n=30) received 20ml of 0.5% bupivacaine hydrochloride at gall bladder bed and sub diaphragmatic space at the end of surgery . All cases were performed by experienced laparoscopic surgeons.

Intensity of pain was assessed on visual analogue scale (VAS) with evaluation at 6, 12, 24, 48 hr postoperative. Analgesic requirements was assessed in terms of requirement of number of Inj. Diclofenac Sodium (75mg) I/m. Nausea and vomiting was assessed depending upon the episodes, number & need for anti emetic medication.

Results and Conclusion .: Intensity of pain was assessed on visual analogue scale (VAS) with evaluation at 6, 12, 24, 48 hr postoperative. . There was found significant difference among both the groups in terms of VAS score, abdominal pain, shoulder pain and analgesic requirement at 12 hours but no such significance was seen in  6, 24 and 48 hours.

To conclude intraperitoneal instillation of Ropivacaine or Bupivacaine reduced post operative pain significantly and amongst two groups. Bupivacaine was better at 12 hrs as shown by decreased VAS score, decreased shoulder tip pain, decreased analgesic requirement. Otherwise at 6, 24 and 48 hrs this difference was not significant among two groups.

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