Analgesic efficacy of intraperitoneal ropivacaine or combined with intravenous paracetamol for laparoscopic cholecystectomy

ABSTRACT

Intraperitoneal instillation of ropivacaine 0.25% immediately before and after surgery and intravenous [IV] administration of paracetamol at the end of surgery may reduce postoperative pain after laparoscopic cholecystectomy. The aim of the study was to examine whether intraperitoneal instillation of ropivacaine with or without IV paracetamol improves postoperative pain after laparoscopic cholecystectomy. After standardized general anesthetic, total of 60 patients were randomly assigned to one of three groups, 20 patients each. Group 1 received intraperitoneal instillation of 20 ml 0.9% saline before and after surgery and IV 100 ml 0.9% saline at the end of surgery [Placebo group]. Group 2 received intraperitoneal instillation of 20 ml ropivacaine 0.25% before and after surgery [total 100 mg ropivacaine] and IV 100 ml 0.9% saline at the end of surgery [Ropi group]. Group 3 received intraperitoneal instillation of 20 ml ropivacaine 0.25% before and after surgery and IV paracetamol 1 gm [in 100 ml bottle] at the end of surgery [Ropi-Para group]. Postoperative pain was rated at 0, 3, 6, 12, and 24 h postoperatively by visual analogue scale scores [VAS]. Total rescue analgesic consumption of morphine during the first 24 h after surgery and time until first analgesic request were recorded. Patients in Placebo group experienced visceral pain mainly and to a lesser extent incisional pain during the first 24 h after surgery. Patients in Ropi group experienced significantly less visceral pain than patients in Placebo group at 3 h after surgery [p < 0.05]. However, there was no significant difference in the intensity of the incisional pain between Ropi and Placebo group at any time after surgery. Patients in Ropi-Para group experienced significantly less visceral and incisional pain than patients in Placebo group at 3 and 6 h after surgery. Patients in Ropi-Para group experienced significantly less incisional pain than patients in Ropi group at 3 and 6 h after surgery. Also, patients in Ropi-Para group experienced significantly less visceral pain than patients in Ropi group at 6 h after surgery. Rescue morphine consumption was significantly less in Ropi-Para group [13 +/- 3 mg] compared to Placebo group [37 +/- 9 mg] [p < 0.001] and Ropi group [21 +/- 5 mg] [p < 0.05]. Also, rescue morphine consumption was significantly less in Ropi group compared to Placebo group [p < 0.05]. Time to first request for analgesia was significantly longer in Ropi-Para group [369 +/- 81 min] compared to Placebo group [35 +/- 29 min] [p < 0.01] and Ropi group [192 +/- 65 min] [p < 0.05]. Also, time to first request for analgesia was significantly longer in Ropi group compared to Placebo group [p<0.05] Intraperitoneal instillation of 20 ml ropivacaine 0.25% before and after surgery [total 100 mg ropivacaine] in addition to IV administration of paracetamol at the end of surgery provides better analgesia after laparoscopic cholecystectomy than that produced by intraperitoneal instillation of ropivacaine alone