title: Comparison of 0.25% Ropivacaine for Intraperitoneal Instillation v/s Rectus Sheath Block for Postoperative Pain Relief Following Laparoscopic Cholecystectomy: A Prospective Study.
abstract: BACKGROUND
  As Laparoscopic Cholecystectomy (LC) is not a totally pain free procedure, with the pain being most intense on the day of surgery and on the following day. Various techniques are available for postoperative pain relief like intraperitoneal instillation of local anaesthetics and rectus sheath block (RSB)which may provide effective pain relief.
  
  
  OBJECTIVE
  To compare the efficacy of preemptive administration (initiated before the surgical procedure) of intraperitoneal instillation and rectus sheath block using ropivacaine for postoperative analgesia after laparoscopic cholecystectomy.
  
  
  METHODS
  A total of 75 selected patients were randomly assigned to three equal groups as Group R, who received bilateral RSB with 0.25 % ropivacaine 15 ml on either side; Group I, who received intraperitoneal instillation of 0.25% ropivacaine 50 ml and Group C (Control group), who received only rescue analgesic on pain. These were compared regarding postoperative analgesia in terms of Visual Analog Scale (0-10 cm), Prince Henry Hospital Pain Score (0-3), time to first dose of rescue analgesic (tramadol), total rescue analgesic consumption in 48 hours, patient satisfaction scores (1-7) and adverse effects.
  
  
  RESULTS
  The time to first rescue analgesic was significantly longer in Group R (16.16±4.73h) and Group I (7.84±1.34h) as compared to Group C (1.72±0.67h), p<0.001. Mean tramadol consumption in 48h for each patient was significantly less in Group R (148±54.92mg) and Group I (202±33.78mg) as compared to Group C (298±22.73mg) p<0.001. Postoperative pain scores were also significantly less in Group R and Group I as compared to Group C during first 6 hours, p<0.05. The difference in above parameters was also significant between Group R and Group I, p<0.05. Thus order of postoperative analgesia effect was: Group R > Group I > Group C. Rescue analgesic requirement showed a 32.21% reduction in Group I and 50.33% reduction in Group R as compared to Group C. Patient Satisfaction Scores (PSS) showed a significant difference among groups with acceptable PSS scores as: Group R (92%) v/s Group I (40%) v/s Group C (20%) p<0.001.
  
  
  CONCLUSIONS
  Pre-emptive administration of rectus sheath block or intraperitoneal instillation of 0.25% ropivacaine was found effective in providing better postoperative analgesia as compared to control group after laparoscopic cholecystectomy. Among these two techniques, rectus sheath block was found to be superior over intraperitoneal instillation.
authors.affiliation: Senior Resident, Department of Anaesthesia, Sampurnanand Medical College , Jodhpur, Rajasthan, India .
authors.forename: Monika
authors.initials: M
authors.lastname: Gupta
authors.affiliation: Professor, Department of Anaesthesia, Rabindra Nath Tagore Medical College , Udaipur, Rajasthan, India .
authors.forename: Udita
authors.initials: U
authors.lastname: Naithani
authors.affiliation: Professor, Department of Anaesthesia, Sampurnanand Medical College , Jodhpur, Rajasthan, India .
authors.forename: Geeta
authors.initials: G
authors.lastname: Singariya
authors.affiliation: Professor, Department of Anaesthesia, Geetanjali Medical College , Udaipur, Rajasthan, India .
authors.forename: Sunanda
authors.initials: S
authors.lastname: Gupta
keywords: Cholecystectomy pain; Local anaesthetics; Prince henry hospital pain score (PHHPS)