A Comparative Study of Effects of Combined Intraperitoneal and Port-Site Infiltration of Bupivacaine versus Ropivacaine on Postoperative Pain after Laparoscopic Cholecystectomy: A Randomised Trial

Introduction: This study was conducted to compare the efficacy of ropivacaine and bupivacaine using a combined intraperitoneal and port-site administration to reduce the postoperative pain in patients undergoing laparoscopic cholecystectomy. Materials and Methods: Eighty patients scheduled for elective laparoscopic cholecystectomy with symptomatic cholelithiasis, 18-65 years, either gender, American society of Anesthesiologists (ASA) class I and II, were included. Patients were allocated into two group’s of40 each after randomization. Group R patients were given 0.375% Ropivacaine 35 mL [25 mL intraperitoneal plus 10 mL at port-site], while Group B patients were given 0.25% Bupivacaine35 mL [25 mL intraperitoneal plus 10 mL at port-site].Noninvasive blood pressure(NIBP),SpO2,Heart rate( HR), Respiratory rate(RR), Visual Analogue Scale(VAS) score and rescue analgesia were noted in post-operative period, at intervals of 0,1, 2, 4, 8, 12 and 24 hours respectively. Results: The demographic and clinical differences between two groups were not significant. The mean HR was comparable in both the groups, except at 12th hour post-operatively where Group R had significantly lower heart rate. The mean SBP was also comparable between the two groups, other than the 4th and 12th hour respectively, Group R values being significantly lower. The mean Diastolic Blood Pressure (DBP) showed a significant reduction in Group R at 8th and 12thhour respectively. At all the time-intervals the VAS score was lower in Group R, up to 12th Hour, at the 12th hour significantly lower VAS scores were observed. In Group R a significantly lower number of rescue analgesia with a longer time for first dose of rescue analgesia was seen during the 24-hour postoperative period. Conclusion: In the early postoperative period as compared to 0.25% bupivacaine, 0.375% of ropivacaine provided good quality analgesia, having no adverse effects with less consumption of postoperative supplemental analgesics and can be incorporated in routine practice.