A clinical comparative study of intraperitoneal instillation of ropivacaine alone or ropivacaine with nalbuphine for postoperative analgesia in laparoscopic cholecystectomy
Abstract
Background & objectives: Intraperitoneal instillation of local anesthetic agents with or without opioids has been proposed to reduce postoperative pain after laparoscopic procedures. So, we did a prospective, randomized, double blind, placebo-controlled study to compare the effectiveness of intraperitoneal 0.2% ropivacaine alone or with nalbuphine for postoperative analgesia in laparoscopic cholecystectomy.
Methodology: A total of 90 patients of ASA class I and II for laparoscopic cholecystectomy procedures were enrolled for this study. The drug was instilled intraperitoneally before the removal of trocar at the end of surgery. In Group-1 (n=30): 0.2% ropivacaine + 2 mg nalbuphine in 20 ml, in Group-2 (n=30): 20 ml 0.2% ropivacaine alone and in Group-3 (n=30) normal saline 20 ml were installed intraperitoneally. Postoperative pain was assessed by visual analogue score for 24 hours and when VAS >4, rescue analgesic was administered. The total amount of rescue analgesics given in the postoperative period and side effects were noted in this study.
Results: Intraperitoneal instillation of ropivacaine with nalbuphine significantly reduced immediate postoperative VAS scores (1.0667 ± 0.78, 3.36 ± 1.37 and 5.53 ± 1.85 in Group-1, 2 and 3 respectively). It also reduced VAS at 8 hours after surgery in the Group-1 (0.8 ± 0. 71) compared to the Group-2 VAS (2.73 ± 1.25). The time for the first rescue analgesic requirement was significantly higher in Group-1 (6.15 h) compared to the Group-2 (4.51 h). Total amount of rescue analgesic was required more in Group-2 and Group-3 compared to Group-1.
Conclusion: Addition of nalbuphine to intraperitoneal ropivacaine significantly prolonges the time to first rescue analgesic requirement and reduces the total consumption of rescue analgesics in 24 hours without any significant increase in adverse events in laparoscopic cholecystectomies.
