Comparative evaluation of postoperative analgesia using 0.25% ropivacaine for intraperitoneal instillation versus ultrasound-guided rectus sheath block in laparoscopic cholecystectomy: A randomized controlled trial

Comparative evaluation of postoperative analgesia using 0.25% ropivacaine for intraperitoneal instillation versus ultrasound-guided rectus sheath block in laparoscopic cholecystectomy: A randomized controlled trial - Background: Effective pain management after surgery is crucial for ensuring optimal recovery and patient contentment, especially in day-care surgery where discomfort can significantly hinder movement and the rehabilitation process. This research aimed to compare the effectiveness of intraperitoneal installation and rectus sheath block using 0.25% ropivacaine for managing postoperative pain in laparoscopic cholecystectomy. Aims and Objectives: The rectus sheath block and intraperitoneal installation of local anaesthetics are two pre-emptive postoperative pain management techniques that may relieve pain. The primary objectives were to compare the Visual Analog Scale (VAS) scores at 30 minutes, 1, 2, 4, 6, 12, 24, and 48 hours. Secondary objectives included determining the time taken for the first rescue analgesic and the consumption of fentanyl in the initial 48 hours. Material and Methods: The prospective randomised study involved eighty-six adult patients randomly divided into two groups of 40 each. Group I, which underwent intraperitoneal instillation, was administered 30 ml of 0.25% ropivacaine prior to surgery, while Group R received a bilateral rectus sheath block with 30 ml of 0.25% ropivacaine before the procedure. Results: The VAS in group R was significantly reduced relative to group I at 6 and 12 h (2.72 ±0.87; 95% CI 0.56 to1.37 and 2.53±0.98; 95% CI 0.51 to 1.56) respectively. Additionally, the time to the first rescue analgesic was considerably longer in Group R (16.30±3.05h) than in Group I (7.92±1.47h), with a p-value 0.001. Over 48 hours, total fentanyl consumption was markedly lower in Group R (745±24.21µg) than in Group I (1520±30.63µg) with 95% CI 762.71 to 787.28. Conclusion: Rectus sheath block with 0.25% ropivacaine provided faster patient recovery and less opioid consumption compared to intraperitoneal instillation following laparoscopic cholecystectomy. Keywords: Ropivacaine, Rectus sheath, Intraperitoneal, Cholecystectomy.