Background: Postoperative pain management remains a major challenge after laparoscopic procedures. Effective pain control encourages early ambulation, which significantly reduces the risk of deep vein thrombosis and to decrease the other risk of complications. 

Aims & Objectives: The present study is designed to evaluate the effect of intraperitoneal instillation with 0.5% ropivacaine as pre insufflation and at the time of closure in patients undergoing laparoscopic cholecystectomy.

Materials and Methods: In this observational study, seventy  patients belonging to ASA I and ASA II aged between 18 to 65 years were randomly allocated to two groups Group A (n=35) and Group B (n=35), undergoing laparoscopic cholecystectomy. Patients belonging to group A received 2 mg/kg of 0.5% ropivacaine before insufflation of gas and patients belonging to Group B received the same as wound infiltration at the time of closure. Injection diclofenac sodium intravenous was given as a rescue analgesia when required. We observed pain intensity with Visual Analogue Scale VAS score at 0.5, 1, 2, 4, 6, 12, 24 h after surgery and over all VAS score (mean of all VAS scores), time for first analgesic requirement, total diclofenac sodium consumption and incidence of nausea and vomiting.

Results: Mean VAS score immediately after the surgery for group A was (2.5±1.2) significantly lower than group B (5.2±2.9, P=0.0001). First analgesic dose requirement time was longer in group A (6.25 hours) than group B(4.50 hours ,P=0.0003). Total amount of diclofenac sodium required in group A(75±4.3mg) was less than group B(160±5.9mg,P=0.054) Incidence of post operative complications  were equal in both  the groups.

Conclusion: Infiltration with 0.5% Ropivacaine significantly decreases post-operative pain intensity and diclofenac sodium consumption in patients undergoing laparoscopic cholecystectomy. Infiltration has better effect when given pre insufflation. 

Keywords: pre insufflation, Post-operative analgesia, laparoscopic cholecystectomy, Ropivacaine.

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Dr Shazada Gani

Sr. Resident, Department, Dept of Anesthesiology, Govt. Medical, College, Srinagar 190010, India