Ropivacaine hydrochloride instillation vs parenteral analgesia (Tramadol) for pain control following laparoscopic cholecystectomy

Background: The use of laparoscopic techniques in general surgery has gained increasing popularity in the last few decades. Patients undergoing laparoscopic cholecystectomy do experience postoperative pain mainly in the upper abdomen, back, and shoulder region that needs narcotic injection as a pain reliever. Intraperitoneal injection of local anesthetic has been proposed to minimize postoperative pain after laparoscopic cholecystectomy. Aim: The aim of this study is to compare the effectiveness of intraperitoneal ropivacaine hydrochloride installation with intramuscular tramadol injection for postoperative pain. Materials and methods: In this study, 400 patients of either sex in the age group of 23 to 62 years with American Society of Anesthesiologists grade I and II, who were scheduled to undergo elective laparoscopic cholecystectomy, were allocated to two groups of 200 patients each with regard to postoperative analgesia. In group I (n = 200) the patients received ropivacaine (0.5%), instilled in gallbladder bed and the undersurface of diaphragm and infiltration of port wounds. In group II (n = 200) the patients were provided with postoperative analgesia with tramadol (100 mg) given intramuscularly (IM) at the completion of procedure. The intensity of postoperative pain using visual analogue scale (VAS) and shoulder pain was evaluated and also other pain-related sequelae were recorded. Results: Both VAS and shoulder pain score had significantly improved postoperatively in group I in comparison with group II. At the same time, ropivacaine instillation in group I lowers significantly postoperative nausea and vomiting resulting from either postoperative pain or tramadol injection. Conclusion: Intraperitoneal installation of ropivacaine hydrochloride reduces the intensity of visceral, parietal, and shoulder pain in comparison with IM tramadol injection.