Comparative Study of Preclosure Periportal Instillation of Three Different Concentrations of Ropivacaine (0.125%, 0.25%, 0.5%) for Postoperative Analgesia in Laparoscopic Cholecystectomy

ABSTRACT

Introduction: Multimodal analgesia is currentlyrecommended for postoperative pain control in laparoscopicsurgeries. Our study aimed at comparing the postoperativeanalgesic efficacy of three different concentrations ofRopivacaine when instilled periportally just before closure inlaparoscopic cholecystectomy.Material and methods: 200 patients posted for laparoscopiccholecystectomy were randomly allocated into four groups of50 patients each. Three groups received preclosure periportalinstillation of 20 ml Ropivacaine 0.125%, 0.25% and 0.5%respectively whereas the fourth group received 20 ml normalsaline. Pain was recorded on visual analog scale at frequentintervals for 24 hours postoperatively and categorised as eithermild, moderate or severe. Tramadol 1mg/Kg was administeredas rescue analgesic in patients with moderate to severe pain.Results: A statistically significant difference was found amongthe four groups with the number of patients experiencingmild and moderate pain with P values of 0.009 and 0.02respectively. The number of patients experiencing mild andmoderate pain was significantly less with Ropivacaine 0.5%when compared with Ropivacaine 0.125% (P=0.01 and 0.03),Ropivacaine 0.25% (P=0.002 and 0.03) and normal saline(P=0.02 and 0.0007). The number of patients requiring rescueanalgesia at various time intervals was also significantly lesswith Ropivacaine 0.5% when compared to the other groups(P<0.05).Conclusion: Ropivacaine 0.5% when administeredas preclosure periportal instillation in laparoscopiccholecystectomy, provided better postoperative analgesiaand significantly less requirement of rescue analgesia, ascompared to equivalent volumes of Ropivacaine in lowerconcentrations of 0.25% and 0.125% which were no betterthan normal saline.