Intraperitoneal instillation of Ropivacaine for postoperative analgesia in laparoscopic cholecystectomy

Abstract

Introduction: Laparoscopic cholecystectomy is one of the most frequently performed elective surgical procedures. Post-operative pain has been reported to be seen in 35-63% of patients undergoing laparoscopic surgeries. Use of intraperitoneal Ropivacaine has been widely advocated in various minimal access abdomino-pelvic surgeries with satisfactory results. Laparoscopic cholecystectomy is a common surgical procedure in our hospital and pain is complained by the patients time and again in the postoperative period especially in the first 24 hours.

Method: A cross sectional descriptive study was conducted in Nepal Medical College and Teaching Hospital among 129 patients. Patients(male/female) aged 18-65 years who were given ropivacaine intraperitoneally during laparoscopic cholecystectomy were included for the study. The post-operative analgesic effect of ropivacaine, a long-acting local anaesthetic agent was assessed.

Result: Total number of female cases was 87 (67.4%) and male cases was 42 (32.6%). One hundred and fifteen (89.1%) patients fell in ASA I and remaining 14 (10.9%) in ASA II. Normal BMI was seen in 89 (69%) patients whereas 1 (0.8) patient was underweight and 39 (30.2) patients were overweight. VAS more than 4 was seen mostly at 8 hours. Adverse effect in postoperative period was seen in 11 patients. Among which 4 (36.3%) patients had tachycardia and PONV was seen in 7 (63.6%) patients

Conclusion: Ropivacaine as intraperitoneal instillation during laparoscopic surgery prolongs the time of post-operative duration of analgesia as assessed by VAS score and need of rescue analgesia.