To evaluate effectiveness of intraperitoneal instillation of 0.5% ropivacaine in reduction of postoperative pain and rescue analgesia.

Abstract

Background and Aim
Postoperative pain management remains a major challenge after laparoscopic procedures.
Pain after laparoscopic surgery has a visceral component as a result of diaphragm irritation by
carbon dioxide. The aim of the study is to evaluate effectiveness of intraperitoneal instillation
of 0.5% ropivacaine in reduction of postoperative pain and rescue analgesia.
Material and Method
After receiving ethical committee approval in NSCB Medical College Jabalpur and consent
of parents ,60 ASA I and ASA II patients of both sex of age group 6-14 years were randomly
allocated to two groups. In group R, 0.5% Ropivacaine was instilled intraperitoneally under
the surface of diaphragm after the creation of pneumoperitoneum. In group C Normal Saline
was instilled instead of ropivacaine. Both the groups were subjected to pre-incisional
periportal infiltration with 1%lignocaine.Heart rate(HR) and Mean Arterial Pressure(MAP)
were recorded after extubation and at 1,2 and 6 hrs.Time to rescue analgesia was noted in
both the groups.
Results
Heart rate after extubation was significantly lower (p<0.0001) in the study group(Mean
81.77±2.75) than the control group(Mean 99.27±1.36).Post-operatively Heart Rate of the
study group at 1hr(Mean 81±2.6),at 2hr(Mean 82.03±2.72) and at 6hr(Mean 82.23±2) was
also significantly lower than the control group(Mean 99.7±1.3).Mean Blood Pressure after
extubation was significantly lower in Group R(Mean 82.23±2.92) than in Group
C(89.07±4).Blood pressure noted postoperatively in Group R at 1hr(Mean 82.17±3),at
2hr(82.30±2) and 6hr(Mean 81.8±2.2) was also significantly lower than Group C(Mean
90.20±2.6).The mean VAS at 6hrs were lower in Group R(<4) in comparison to Group C(>4)
and was statistically significant at 0,1, 2 and 6hrs.
Conclusion
Intraperitoneal instillation of ropivacaine is a safe and effective modality of providing
analgesia that improves postoperative haemodynamics and increases time to rescue analgesia.