A COMPARITIVE EVALUATION OF INTRAPERITONEAL SUBDIAPHRAGMATIC INSTILLATION OF LEVOBUPIVACAINE VERSUS ROPIVACAINE FOR SHOULDER TIP PAIN AFTER LAPAROSCOPIC CHOLECYSTECTOMY; A DOUBLE BLIND PLACEBO CONTROLLED STUDY

Abstract

Background: Shoulder tip pain associated with laparoscopic surgeries may cause more discomfort to the patient than the pain at the incision sites. Direct intraperitoneal sub diaphragmatic instillation of local anaesthetics (LA) can provide a simple and effective means to overcome this problem. This randomized, double-blind, placebo controlled trial compared the effects of intraperitoneal sub diaphragmatic instillation of ropivacaine and levobupivacaine for the relief of shoulder tip pain after laparoscopic cholecystectomy.

Methods: After approval from the ethical committee of our institute ninety patients of either sex belonging to American Society of Anesthesiologists (ASA) physical status class I or II, between 20-60 years of age, scheduled to undergo laparoscopic cholecystectomy were randomly allocated using sealed envelopes to one of the three groups: Group L (n=30), Group R (n=30) and Group S (n=30) Patients received 10ml of 0.25% levobupivacaine, 0.25% ropivacaine and saline under each dome of diaphragm respectively before deflation of pnuemoperitonem. Shoulder tip pain(STP) and abdominal pain was assessed by using the visual analogue scale (VAS) at 0, 2, 4, 8 and 24 hours after the completion of the procedure at rest, on movement (sitting up in bed and/or turning sideways in bed) and on coughing. Also time for first request for analgesia by the patient, the total consumption of analgesic in 24 hours and incidence of nausea and/or vomiting was observed.

Results and Conclusion: Use of levobupivacaine and ropivacaine significantly reduced the incidence and intensity of STP, total amount of analgesic used and increased the mean time for first request for analgesia. Both levobupivacaine (0.25%) and ropivacaine (0.25%) are effective for this purpose, though levobupivacaine relieved pain for a longer duration.

Keywords: Shoulder tip pain, acute pain, intraperitoneal local anaesthetic, subdiaphragmatic local anaesthetic, Laparoscopic cholecystectomy, levobupivacaine, Ropivacaine, postoperative.