title: A comparison of intraperitoneal bupivacaine-tramadol with bupivacaine-magnesium sulphate for pain relief after laparoscopic cholecystectomy: A prospective, randomised study.
abstract: OBJECTIVE
  In laparoscopic surgeries, intraperitoneal instillation of local anaesthetics and opioids is gaining popularity, for better pain relief. This study compared the quality and duration of post-operative analgesia using intraperitoneal tramadol plus bupivacaine (TB) or magnesium plus bupivacaine (MB).
  
  
  METHODS
  In this study, 186 patients undergoing laparoscopic cholecystectomy were randomly divided into two groups: group TB received intraperitoneal tramadol with bupivacaine and group MB received intraperitoneal magnesium sulphate (MgSO4) with bupivacaine. The visual analogue scale (VAS) to assess pain, haemodynamic variables and side effects were noted and compared at different time points. The primary outcome was to compare the analgesic efficacy and duration of pain relief. The secondary outcomes included comparison of haemodynamic parameters and side effects among the two groups. The data analysis was carried out with unpaired Student'st-test and Chi-square test using software SPSS 20.0 version.
  
  
  RESULTS
  The mean of VAS pain score after 1, 2, 4, 6 and 24 h of surgery was more in TB group compared to MB group, and the difference was statistically significant (P< 0.05). The total rescue analgesia consumption in 24 h after surgery was 2.4 g (mean) of paracetamol in TB group and 1.4 g (mean) of paracetamol in MB group which was statistically significant (P< 0.05). There were no statistically significant differences in the secondary outcomes.
  
  
  CONCLUSIONS
  Intraperitoneal instillation of bupivacaine-MgSO4renders patients relatively pain-free in first 24 h after surgery, with longer duration of pain-free period and less consumption of rescue analgesic as compared to bupivacaine-tramadol combination.
authors.affiliation: Department of Anaesthesiology and Critical Care, Bhopal Memorial Hospital and Research Centre, Bhopal, Madhya Pradesh, India.
authors.forename: Anurag
authors.initials: A
authors.lastname: Yadava
authors.affiliation: Department of Anaesthesiology and Critical Care, Bhopal Memorial Hospital and Research Centre, Bhopal, Madhya Pradesh, India.
authors.forename: Sunil K
authors.initials: SK
authors.lastname: Rajput
authors.affiliation: Department of Anaesthesiology and Critical Care, Bhopal Memorial Hospital and Research Centre, Bhopal, Madhya Pradesh, India.
authors.forename: Sarika
authors.initials: S
authors.lastname: Katiyar
authors.affiliation: Department of Anaesthesiology and Critical Care, Bhopal Memorial Hospital and Research Centre, Bhopal, Madhya Pradesh, India.
authors.forename: Rajnish K
authors.initials: RK
authors.lastname: Jain
keywords: Laparoscopic cholecystectomy; magnesium sulphate; post-operative analgesia