Postoperative analgesia with intraperitoneal ropivacaine with and without fentanyl after laparoscopic cholecystectomy: A randomized double-blind controlled trail

Introduction Surgical procedures have been improved to reduce trauma, morbidity, mortality and hospital stay, with consequent reduction in healthcare costs. Patients undergoing laparoscopic procedures do experience postoperative pain, especially in upper and lower abdomen and back and shoulder regions. Intraperitoneal injections of local anaesthetic have been proposed to minimize postoperative pain after laparoscopic surgery. Therefore, this randomized, placebocontrolled study was conducted to compare the effectiveness of intraperitoneal ropivacaine with or without fentanyl for postoperative analgesia after laparoscopic surgery. Materials and methods Patients were randomized into three groups (n = 50) using a computergenerated table of random numbers. All surgeries were carried out under general anaesthesia, and patients were instructed preoperatively about grading the intensity of pain in the postoperative period as per visual analogue scale and verbal rating scale. The drug was injected intraperitoneally before the removal of trocar at the end of surgery. Results Visual analogue scale scores immediately postoperatively were 44.00 ± 19.16 (vs 22.20 ± 5.06 vs 23.20 ± 8.67; p < 0.001) and at 6th hour 35.40 ± 9.52 (vs 29.40 ± 4.24 vs 27.80 ± 5.0; p < 0.001). Similarly, verbal rating scale score (2.60 ± 0.88 vs 1.96 ± 0.74 vs 1.62 ± 0.56) was signiϐicantly reduced immediately postoperatively in Group 3. At the 6th hour verbal rating scale scores were 2.32 ± 0.79 vs 1.94 ± 0.42 vs 1.80 ± 0.49, which showed signiϐicantly less pain in patients receiving ropivacaine with fentanyl. Total analgesic consumption was also signiϐicantly lower in Group 3 patients (p < 0.001) in comparison to Group 1 and Group 2. In Group 1, the total analgesic (diclofenac) consumption was 149 ± 42 mg; in Group 2, 97 ± 47 mg; and in Group 3, 84 ± 25 mg. Conclusion Intraperitoneal instillation of ropivacaine with fentanyl reduces not only the intensity of visceral, parietal and shoulder pain but also the total rescue analgesic dose consumption.