Intraperitoneal Ropivacaine versus Levobupivacaine for Postoperative Analgesia in Laparoscopic Surgeries: A Randomised Controlled Trial

Introduction: Management of postoperative pain in laparoscopic surgeries remains challenging, often necessitating multimodal analgesic strategies to enhance patient comfort and recovery. Intraperitoneal Local Anaesthetic (IPLA) administration offers a promising approach for pain control while minimising systemic opioid use and associated side-effects. Ropivacaine and levobupivacaine are commonly used long-acting amide local anaesthetics with favourable safety profiles. Aim: The present aimed to compare the efficacy of intraperitoneal ropivacaine versus levobupivacaine for postoperative analgesia in patients undergoing elective laparoscopic surgeries. Materials and Methods: In the present double blinded, randomised controlled study, 48 patients {American Society of Anaesthesiologists (ASA) I-II, aged 18-65 years} undergoing elective laparoscopic surgeries were randomly allocated into two groups. Group R (n=24) received 20 mL 0.25% ropivacaine and group L (n=24) received 20 mL 0.25% levobupivacaine intraperitoneally before trocar removal. Postoperative pain was assessed using Visual Analog Scale (VAS) scores over 12 hours. Haemodynamic parameters, rescue analgesic requirements, and side-effects were monitored. Data were analysed using Statistical Package for Social Sciences (SPSS) version 26, with independent t-tests for normally distributed numerical variables and Chi-square tests for categorical variables, with statistical significance set at p<0.05. Results: Both groups were comparable in demographic characteristics with mean (SD) age being 35.42±10.4 and 35.04±10.8 years in group L and group R, respectively. VAS scores were similar until five hours, after which group L showed significantly lower scores upto 10 hours. Rescue analgesia requirements peaked at five hours (group L: 20.8% vs group R: 16.7%, p<0.001) with no requirements after six hours in either group. Haemodynamic parameters remained stable except for significantly lower Systolic Blood Pressure (SBP) in group L at specific time points. The side-effects were minimal. Most patients in group L (87.5%) and group R (79.2%) had no sideeffects. Nausea was the same in both groups (12.5%), but vomiting (8.3%) happened only in group R. Conclusion: Both ropivacaine and levobupivacaine provide effective postoperative analgesia when administered intraperitoneally in laparoscopic surgeries. Levobupivacaine demonstrated superior pain control after five hours, making it a potentially preferable option.