COMPARISON OF INTRAPERITONEAL INSTILLATION OF BUPIVACAINE VERSUS ROPIVACAINE FOR POSTOPERATIVE ANALGESIA IN LAPAROSCOPIC CHOLECYSTECTOMY: A PROSPECTIVE, RANDOMIZED, DOUBLE-BLIND STUDY

Dr. Sanjay Jarwal, Dr. Nipun Lamba, Dr. P S Lamba

Abstract


BACKGROUND AND AIMS: Laparoscopic operative procedures have revolutionized surgery with many advantages: a smaller and more
cosmetic incision, reduced blood loss, reduced postoperative stay and pain, which cut down on hospital cost. Although, there are clear benefits
compared with open surgery, post‐operative pain after laparoscopic cholecystectomy remains an issue. The Aimed of our study was to compare the
efficacy of intraperitoneal instillation of bupivacaine and ropivacaine for postoperative pain relief in patients undergoing laparoscopic
cholecystectomy.
METHOD: After approval from institutional ethical committee this randomized double blind study was carried out in the department of the
Anaesthesiology. 92 patients aged 20-70 years, ASA status I & II and within 50-80 kg weight, scheduled for laparoscopic cholecystectomy were
randomly divided into two groups with 46 patients in each group. Group(A) patients received 0.5% bupivacaine in a dose of 2 mg/kg and Group(B)
patients received 0.75% ropivacaine in a dose of 2 mg/kg, both drugs diluted in normal saline to make a solution of 50 ml. The Drug solution was
instilled intraperitoneally through the infra-umbilical trocar at the end of surgery in Trendelenburg's position to facilitate the dispersion of the drug
solution in the subhepatic region. NIBP, HR, SPO2, VAS, VRS (verbal rating scale) and rescue analgesia were recorded immediately
postoperatively and then regularly every hour for the next 12 hours.
RESULT: The age and sex distribution of both groups were similar. The pulse rate, systolic & diastolic blood pressure were comparatively lower in
Group (B than in Group (A). The VAS score was significantly (p < 0.05) lower in ropivacaine group (B) from postoperative 4th, 5th and 7hr to12th
hr. Rescue analgesia was given when VAS was >40. VRS score was significantly lower in Group(B) immediate postoperative period ,1th and then
from 3hrs to 12 hours showing longer duration of analgesia in this group. The rescue analgesic requirement was also less in Group (B). total
analgesic consumption was significantly lower in ropivacaine group (89.52±30.12) compare to bupivacaine group (107.14±41.06) respectively
P=0. 047.
CONCLUSION: We conclude that the instillation of local anesthetic solution intraperitoneally was an easy, non-invasive and effective method of
postoperative pain relief in laparoscopic cholecystectomy. Ropivacaine provided analgesia for longer duration as compared to bupivacaine.


Keywords


Laparoscopic Cholecystectomy; Intraperitoneal; Local Anesthetic; Bupivacaine; Ropivacaine

Full Text:

PDF

References


Carr DB. Goudas LC. Acute pain. Lancet 1999; 353: 2051-62

Grubb BD. Peripheral and central mechanisms of pain: Br J Anaesth 1998; 81:8

Gupta R, Bogra J, Kothari N, Kohli M. Postoperative analgesia with intraperitoneal fentanyl and bupivacaine: a randomized control trial Canadian Journal on Medicine. 2010;1,1‐11.

Boddy AP, Mehta S, Rhodes M. The effect of intraperitoneal local anesthesia in laparoscopic cholecystectomy: a systematic review and meta‐analysis. Anesth Analg. 2006;103(3):682‐8.

Warltier DC, Pagal PS, Kersten JR. Approaches to the prevention of preoperative myocardial ischemia. Anesthesiology 2000; 92: 253.

Sharan R, Singh M, Kataria AP, Jyoti K, Jarewal V, Kadian R. Intraperitoneal instillation of bupivacaine and ropivacaine for postoperative analgesia in laparoscopic cholecystectomy. Anesth Essays Res 2018;12:377‑80.

Gupta A, Thorn SE, Axelsson K, Larsson LG, Agren G, Holmström B, Rawal N. Postoperative pain relief using intermittent injections of 0.5% ropivacaine through a catheter after laparoscopic cholecystectomy. Anesth Analg. 2002 Aug;95(2):450‐6.

Tae Han Kim ,Hyun Kang, Jun Seok Park, Taik Chang, Sun Gyoo Park. Intraperitoneal Ropivacaine Instillation for Postoperative Pain Relief after Laparoscopic Cholecystectomy. J Korean Surg, 2010; 79: 130-136

Goldstein A, Grimault P, Henique A, Keller M, Fortin A, Darai E. Preventing postoperative pain by local anesthetic instillation after laparoscopic gynecologic surgery: a placebo‐controlled comparison of bupivacaine and ropivacaine. Anesth Analg. 2000;91(2):403‐7

Meena RK, Meena K, Loha S, Prakash S. A comparative study of intraperitoneal ropivacaine and bupivacaine for postoperative analgesia in laparoscopic cholecystectomy: a randomized controlled trial. Anaesth Pain & Intensive Care. 2016 Sep 1;20(3):295-302.

Khurana S, Garg K, Grewal A, Kaul TK, Bose A. A comparative study on postoperative pain relief in laparoscopic cholecystectomy: Intraperitoneal bupivacaine versus combination of bupivacaine and buprenorphine. Anesth Essays Res 2016;10:23‑8.

Kucuk C, Kadiogullari N, Canoler O, Savli S. A placebo‐controlled comparison of bupivacaine and ropivacaine instillation for preventing postoperative pain after laparoscopic cholecystectomy. Surg Today. 2007;37(5):396‐400.

Narchi P, Benhamou D, Fernandez H. Intraperitoneal local anaesthetic for shoulder pain after day-case laparoscopy. Lancet. 1991 Dec 21-28;338(87828783):1569–70. [PubMed]

Chundrigar T, Hedges AR, Morris R, Stamatakis JD. Intraperitoneal bupivacaine for effective pain relief after laparoscopic cholecystectomy. Ann R Coll Surg Engl. 1993 Nov;75(6):437–9. [PubMed] [Free full text]


Refbacks

  • There are currently no refbacks.