Comparative Study of Intraperitoneal Ropivacaine vs. Lignocaine Nebulisation for Postoperative Pain and Hemodynamic Stability in Laparoscopic Cholecystectomy

Background: Laparoscopic cholecystectomy, the gold standard treatment for gallbladder stones, offers significant advantages such as reduced postoperative pain, shorter hospital stays, and quicker recovery.However, postoperative pain, particularly diffuse abdominal and shoulder pain, remains a concern, necessitating effective pain management strategies.Methods: This prospective, randomized, double-blind study included 60 patients aged 20-50 years, ASA grade 1 and 2, undergoing laparoscopic cholecystectomy at MKCG Medical College & Hospital from September 2014 to October 2016.Patients were randomly assigned to receive intraperitoneal nebulization of either 1% ropivacaine (Group 1) or 4% lignocaine (Group 2).Pain levels were assessed using the Visual Analogue Scale (VAS) at various intervals up to 48 hours postoperatively.Hemodynamic parameters, rescue analgesia requirements, incidence of shoulder pain, nausea, vomiting, and urine output were also monitored.Results: Group I (ropivacaine) demonstrated a significantly longer duration of analgesia (220±62.5 minutes) compared to Group II (lignocaine) (51±13.9minutes) with a highly significant p-value of 0.00.Mean VAS scores indicated lower pain levels in the lignocaine group immediately post-surgery but higher pain levels after 30 minutes, 1 hour, and 2 hours, necessitating more frequent rescue analgesia.Hemodynamic parameters showed better stability with ropivacaine beyond the first two hours postsurgery.The incidence of shoulder pain, nausea, vomiting, and reduced urine output were comparable between the groups and not statistically significant. Conclusion:Intraperitoneal nebulisation of ropivacaine is superior to lignocaine in providing longer postoperative analgesia and better hemodynamic stability in laparoscopic cholecystectomy.This technique should be considered a valuable addition to pain management protocols in minimally invasive surgeries to improve patient outcomes and satisfaction.