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

Volume : IX, Issue : I, January - 2020

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