Title: Effects of Intraperitoneal Instillation of Local Anesthetic Agents in Laparoscopic Cholecystectomy –A Clinical Comparison Between 0.5% Lignocaine, 0.2% Ropivacaine & 0.125%Bupivacaine
Authors: Pacharla Indira, Rajola Raghu, Anepu Kiran Kumar
DOI: http://dx.doi.org/10.18535/jmscr/v4i1.22
Introduction: Minimal access surgery offers advantages to patients in terms of reduced peri-operative morbidity andshortened recovery times. Objective:To compare the effects of intraperitoneal instillation of lignocaine, bupivacaine and ropivacaine in patients undergoing laparoscopic cholecystectomy. Material and Methods: 75 adult patients of ASA physical status I and II in the age group of 20 – 55 yrs were enrolled in the study and divided into 3 groups of 25 each .Group L :20 ml of 0.5% Lignocaine, Group B: 20 ml of 0.125% Bupivacaine , Group R : 20 ml of 0.2% Ropivacaine respectively were instilled intraperitoneally before CO2 Insufflation . Results: Age and sex distribution in all the groups were similar. Heart rate, Systolic & Diastolic Blood pressure, Mean arterial blood pressure and mean trend of SpO2 in all the groups remained similar over the periods. The mean visual analog score in all groups varied considerably within (between time) and between the groups (treatment) especially comparatively higher in Group L at initial hours 15 min to 30 min and at end hours 12-24 hrs as compared to Group B. On an average, the frequency of dosing and mean no. of rescue analgesic doses were higher in Group L, B than R. Conclusion: We conclude that intraperitoneal instillation of local anaesthetic is an easy, cheap, and reliable method of providing good perioperative analgesia and hemodynamic stability in laparoscopic cholecystectomy . Keywords:Bupivacaine, Intraperitoneal Local Anaesthetic , Laparoscopic cholecystectomy,. Lignocaine, Ropivacaine. 1. 1. Michaloliakou C, Chung F, Sharma S. Preoperative multimodal analgesia facilitates recovery after ambulatory laparoscopic cholecystectomy. Anesth Analg1996; 82: 44–51 2. Griffin EM, Prystowsky H, Hingson RA. The use of topical anaesthesia of the peritoneum in poor risk surgery and in augmenting inadequate vertebral conduction anaesthesia. N Z Med J. 1951;50:31–3. 3. Ng A, Swami A, Smith G, Davidson AC, Emembolu J. The analgesic effects of intraperitoneal and incisional bupivacaine with epinephrine following total abdominal hysterectomy. Anesth Analg 2002; 95: 158–62 4. Moiniche S, Jorgensen H, Wetterslev J, Berg J. Local anesthetic infiltration for postoperative pain relief after laparoscopy: a qualitative and quantitative systematic review of intraperitoneal, port‐site infiltration and mesosalpinx block.Anesth Analg 2000; 90: 899–912. 5. Simpson RB, Russell D. Anaesthesia for daycase gynaecological laparoscopy: a survey of clinical practice in the United Kingdom. Anaesthesia 1999; 54: 51–85 6. Joris JL, Chiche JD, CanivetJL, et al : Haemodynamic changes induced by laparoscopy and their endocrine correlates. J Am Coll Cardiol 1998; 32:1389. 7. Kahokehr A, Sammour T, Shoshtari KZ, Taylor M, Hill AG. Intraperitoneal local anesthetic improves recovery after colon resection: A double-blinded randomized controlled trial. Ann Surg. 2011;254:28–38. 8. Narchi P, Benhamou D, Fernandez H. Intraperitoneal local anaesthetic for shoulder pain after day case laparoscopy. Lancet. 1991;338:1569–70. 9. Liu SS, Hodgson PS. Local anaesthetics. In: Barash PG, Cullen BF, Stoelting RK, editors. Clinical anaesthesia. 4th ed. Philadelphia: Lippicott Williams and Wilkins; 2001. pp. 449–69. 10. Hernández-Palazón J, Tortosa JA, Nuño de la Rosa V, Giménez-Viudes J, Ramírez G, Robles R. Intraperitoneal application of bupivacaine plus morphine for pain relief after laparoscopic cholecystectomy. Eur J Anaesthesiol. 2003;20:891–6. 11. Chundrigar T, Hedges AR, Morris R, Stamatakis JD. Intraperitoneal bupivacaine for effective pain relief after laparoscopic cholecystectomy. Ann R Coll Surg England. 1993;75:437–9. 12. Stein C. Peripheral mechanisms of opioid analgesia. Anesth Analg. 1993;76:182–91. 13. Malhotra N, Chanana C, Roy KK, Kumar S, Rewari V, Sharma JB. To compare the efficacy of two doses of intraperitoneal bupivacaine for pain relief after operative laparoscopy in gynecology. Arch Gynecol Obstet. 2007;276:323–6. Abstract
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