Evaluation of role of peri portal infiltration of ropivacaine in post laparoscopic cholecystectomy pain management: a randomized controlled double-blind study
DOI:
https://doi.org/10.18203/2349-2902.isj20232330Keywords:
Analgesia, Laparoscopic cholecystectomyAbstract
Background: Laparoscopic cholecystectomy is considered as the treatment of choice for symptomatic cholelithiasis. The present study was conducted to assess the role of peri-portal infiltration of ropivacaine in post laparoscopic cholecystectomy pain management.
Methods: A total of 100 eligible cases undergoing laparoscopic cholecystectomy were randomly allocated in two groups: group A (received infiltration of total 20 ml of 0.5% ropivacaine, 5 ml in each port site after removal of trocar, and group B (received placebo i.e., 20 ml normal saline). Postoperative pain was assessed using Wong Baker facial pain scale at 6, 12 and 18 hours and use of rescue analgesics were noted.
Results: Group I comprised of 27 males and 23 females and group II had 25 males and 25 females. The mean heart rate in group I was 85.4 and in group II was 86.2. Respiratory rate was 14.2 cycles/minute in group I and 15.2 cycles/minute in group II. The mean blood pressure was 134.2/74.6 mmHg in group I and 136.4/75.2 mmHg in group II and oxygen saturation was 99.2% in group I and in group II was 99.5%. The mean VAS scores were significantly lower in group A cases as compared to group B, throughout the study follow up (p<0.01). 70% in group A and 90% in group B required 1 dose and 10% in group II required 2 doses. Duration of rescue analgesia was 21.49 minutes in group A and 17.3 minutes in group B.
Conclusions: Peri-portal infiltration of ropivacaine is effective in reducing post laparoscopic cholecystectomy pain. Mean duration of analgesia was significantly more and requirement of rescue analgesics were significantly less in cases managed by peri-portal infiltration of ropivacaine as compared to control group (using NSAIDs).
References
Barkun JS, Wexler MJ, Hinchey EJ, Thibeault D, Meakins JL. Laparoscopic versus open inguinal herniorrhaphy: preliminary results of a randomized controlled trial. Surgery. 1995;118:703-10
Boddy AP, Mehta S, Rhodes M. The effect of intraperitoneal local anesthesia in laparoscopic cholecystectomy: a systematic review and meta-analysis. Anesth Analg. 2006;103:682-8.
Bisgaard T, Kehlet H, Rosenberg J. Pain and convalescence after laparoscopic cholecystectomy. Eur J Surg. 2001;167(2):84-96.
Bisgaard T, Klarskov B, Rosenberg J, Kehlet H. Factors determining convalescence after uncomplicated laparoscopic cholecystectomy. Arch Surg. 2001;136:917-21
Alkhamesi N, Peck D, Lomax D, Darzi A. Intraperitoneal aerosolization of bupivacaine reduces postoperative pain in laparoscopic surgery: a randomized prospective controlled double-blinded clinical trial. Surg Endosc. 2007;21:602-6.
Bisgaard T. Analgesic treatment after laparoscopic cholecystectomy: a critical assessment of the evidence. 2006. In: Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews. New York (UK): Centre for Reviews and Dissemination (UK); 1995.
Wall PD, Melzack R. Pain measurements in persons in pain: In: Wall PD, Melzak R, editors. Textbook of Pain. 4th edn. Churchill Livingstone; 1999:409-426.
Yaksh TL, Hammond DL. Peripheral and central substrates involved in the rostrad transmission of nociceptive information. Pain. 1982;13(1):1-85.
Ness TJ, Gebhart GF. Visceral pain: a review of experimental studies. Pain. 1990;41(2):167-234.
McMahon SB, Dmitrieva N, Koltzenburg M. Visceral pain. Br J Anaesth. 1995;75(2):132-44.
Bijalwan A, Sharma JP, Dutta M, Sharma SC, Beg MA. Evaluation of the effect of periportal infiltration of ropivacaine in laparoscopic cholecystectomy patients: a randomized double-blind, placebo-controlled study in a tertiary-care teaching hospital. Int J Med Sci Public Health. 2015;4(5):721-6.
Di Pace MR, Cimador M, Catalano P, Caruso A, Sergio M, Casuccio A, et al. Efficacy of periportal infiltration and intraperitoneal instillation of ropivacaine after laparoscopic surgery in children. J Laparoendosc Adv Surg Tech. 2009;19(6):821-5.
Pavlidis TE, Atmatzidis KS, Papaziogas BT, Makris JG, Lazaridis CN, Papaziogas TB. The effect of preincisional periportal infiltration with ropivacaine in pain relief after laparoscopic procedures: a prospective, randomized controlled trial. JSLS. 2003;7(4):305-10.
