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Category: Volume 07 Issue 01 January 2019
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Title: Intra peritoneal installation of Ropivacaine compared to Ropivacaine plus Tramadol and Ropivacaine plus Dexmedetomidine for analgesic efficacy in laparoscopic cholecystectomy

Authors: Sanjay Kalsotra, Vishal Kant, Mushtaq Ahmad Rather

 DOI: https://dx.doi.org/10.18535/jmscr/v7i1.158

Abstract

Background and Aims: In laparoscopic surgeries, intraperitoneal instillation of local anesthetics alone or in combination with non-opioids is gaining popularity, for better post-operative pain relief. This study compared the analgesic efficacy with regard to quality and duration of post‑operative analgesia and also total amount of rescue analgesia required in 24 hrs using intraperitoneal Ropivacaine (R), Ropivacaine plus tramadol (RT) or Ropivacaine plus dexmedetomidine (RD).

Methods: In this study, 123 patients undergoing laparoscopic cholecystectomy were divided into three groups: Intraperitoneal Ropivacaine 50 ml 0.2% +5 ml normal saline (NS):Group R(n=37),Intraperitoneal Ropivacaine 50 ml 0.2% + Tramadol 1 mg/kg (diluted in 5 ml NS):Group RT(n=41) and intraperitoneal Ropivacaine 50 ml 0.2%+Dexmedetomidine 1μg/kg (diluted in 5 ml NS):Group RD(n=45) before removal of trocar at the end of surgery. The quality of analgesia was assessed by visual analogue scale score (VAS), time to first request of analgesia and total dose of analgesic in the first 24 hrs. Hemodynamic parameters and adverse effects in three groups over 24 hrs were also noted. Statistical analysis was performed using Microsoft (MS) Office Excel Software with the Chi‑square test and fisher’s exact test (level of significance P = 0.05).

Results: The mean of VAS pain score after 0.5,1, 2, 4, 6, 12 and 24 hrs of surgery was less in RD group compared to other two groups, and the difference was statistically significant (P < 0.05). Mean time of 1st request of analgesia was 63.7 min in group R, 116.9 min in group RT and 141.8 min in group RD which was statistically significant (P < 0.05). The mean total rescue analgesia consumption of inj. diclofenac in group RD was 81.70 mg, 109.80 mg in group RT and 140.60 mg in group R in 24 hrs after surgery which was statistically significant (P < 0.05). There were no statistically significant differences in the secondary outcomes.

Conclusion: Intraperitoneal instillation of ropivacaine‑dexmedetomidine renders patients relatively pain‑free in first 24 hrs after surgery, with longer duration of pain‑free period and less consumption of rescue analgesic as compared to ropivacaine‑tramadol combination and ropivacaine only.

Keywords: laparoscopic cholecystectomy, Ropivacaine, Tramadol, Dexmedetomidine, visual analogue scale score (VAS).

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Corresponding Author

Dr Mushtaq Ahmad Rather

Consultant, Department of Anesthesia & Critical Care Govt. Medical College Srinagar, Kashmir, India

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