Comparison of Ropivacaine and Bupivacaine in Intraperitoneal Instillation for Postoperative Analgesia in Laparoscopic Cholecystectomy: A Randomized Controlled Trial

Abstract

Introduction Laparoscopic cholecystectomy, despite its several advantages, is sometimes associated with discomfort due to pain in the immediate postoperative period. Effective management of this pain is critical for enhancing recovery, minimizing complications, and facilitating early discharge. The use of local anesthetics for intra-abdominal analgesia, specifically bupivacaine and ropivacaine, has been investigated as a means to improve postoperative pain control. This study aims to compare the analgesic efficacy of intra-peritoneal ropivacaine versus bupivacaine following laparoscopic cholecystectomy. Methods This prospective, randomized, comparative study was conducted after obtaining institutional ethics committee clearance. Sixty ASA grade I/II patients, aged 18 to 65 years, undergoing elective laparoscopic cholecystectomy were enrolled. Patients were randomly assigned to receive either 35 ml of 0.375% ropivacaine (Group R) or 35 ml of 0.25% bupivacaine (Group B) administered intra-peritoneally. Analgesic efficacy was assessed using Visual Analogue Scale (VAS) scores, heart rate monitoring, and the requirement for rescue analgesia. Data were collected at various time intervals and analyzed using statistical methods. Results Mean heart rate values were significantly lower in Group R compared to Group B from the 2nd to 8th hour and at the 18th hour postoperatively (p < 0.05). The mean VAS scores for pain at rest were significantly lower in Group R compared to Group B from the 8th to 24th hour (p < 0.001). A substantially higher proportion of patients in Group B required rescue analgesia compared to Group R (p < 0.05). Specifically, 16.7% of patients in Group R required rescue analgesia versus 43.3% in Group B. The time to the first dose of rescue analgesia was longer in Group R (8.4±3.6 hours) compared to Group B (6.8±11.3 hours), though this difference was not statistically significant (p > 0.05). Total analgesic consumption was significantly higher in Group B (20.5±3.2 mg) compared to Group R (14.6±2.8 mg) (p < 0.001). Conclusion Ropivacaine provides superior postoperative analgesia compared to bupivacaine when used for intra-peritoneal instillation in laparoscopic cholecystectomy. The findings support the use of ropivacaine for effective pain management in this surgical context, potentially leading to improved patient outcomes and reduced opioid consumption.

Keywords: bupivacaine; intra-peritoneal analgesia; laparoscopic cholecystectomy; postoperative pain; rescue analgesia; ropivacaine; visual analogue scale.