Page 24 - Journal of Laparoscopic Surgery - WALS Journal

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Mahmoud AL Bahram et al 10.5005/jp-journals-10033-1264
ORIGINAL ARTICLE

Ropivacaine Hydrochloride Instillation vs Parenteral

Analgesia (Tramadol) for Pain Control following
Laparoscopic Cholecystectomy

2
1 Mahmoud AL Bahram, Ahmed A Monem, Amir K Saleh
3
ABSTRACT How to cite this article: Bahram MAL, Monem AA, Saleh AK.
Ropivacaine Hydrochloride Instillation vs Parenteral
Background: The use of laparoscopic techniques in general Analgesia (Tramadol) for Pain Control following Laparoscopic
surgery has gained increasing popularity in the last few Cholecystectomy. World J Lap Surg 2016;9(1):22-25.
decades. Patients undergoing laparoscopic cholecystectomy
do experience postoperative pain mainly in the upper abdomen, Source of support: Nil
back, and shoulder region that needs narcotic injection as a pain Conflict of interest: None
reliever. Intraperitoneal injection of local anesthetic has been
proposed to minimize postoperative pain after laparoscopic
cholecystectomy. INTRODUCTION
Aim: The aim of this study is to compare the effectiveness Laparoscopic cholecystectomy has been proven to reduce
of intraperitoneal ropivacaine hydrochloride installation with
intramuscular tramadol injection for postoperative pain. postoperative pain significantly and shorten the recovery
period, therefore reducing discharge time from 1 to 3
Materials and methods: In this study, 400 patients of either days to same day discharge with an earlier return to
sex in the age group of 23 to 62 years with American Society 1
of Anesthesiologists grade I and II, who were scheduled to normal activities.
undergo elective laparoscopic cholecystectomy, were allocated After laparoscopic cholecystectomy, 35 to 63% of
to two groups of 200 patients each with regard to postoperative patients complain more of visceral pain as a result of
analgesia. In group I (n = 200) the patients received ropivacaine stretching of the intra-abdominal cavity, peritoneal
(0.5%), instilled in gallbladder bed and the undersurface of
diaphragm and infiltration of port wounds. In group II (n = 200) inflammation, and phrenic nerve irritation caused
the patients were provided with postoperative analgesia with by residual carbon dioxide in the peritoneal cavity.
tramadol (100 mg) given intramuscularly (IM) at the completion Postoperative abdominal pain usually occurs during the
of procedure. The intensity of postoperative pain using visual first 24 hours, while shoulder pain most commonly appears
analogue scale (VAS) and shoulder pain was evaluated and the second day after laparoscopic cholecystectomy. 2
also other pain-related sequelae were recorded.
Perioperative analgesia has traditionally been provided
Results: Both VAS and shoulder pain score had significantly by opioid analgesics. However, extensive use of opioids
improved postoperatively in group I in comparison with group II. is associated with a variety of perioperative side effects,
At the same time, ropivacaine instillation in group I lowers such as respiratory depression, drowsiness, postoperative
significantly postoperative nausea and vomiting resulting from
either postoperative pain or tramadol injection. nausea and vomiting, ileus, and constipation that can
delay hospital discharge. 3
Conclusion: Intraperitoneal installation of ropivacaine Intraperitoneal administration of some drugs can be ef-
hydrochloride reduces the intensity of visceral, parietal, and 2
shoulder pain in comparison with IM tramadol injection. fective for relief of pain after laparoscopic cholecystectomy.
Clinical studies have investigated the use of regional
Keywords: Cholecystectomy, Laparoscopy, Pain.
local anesthetics, in combination with other modalities
for pain relief following laparoscopic cholecystectomy to
avoid the adverse effects of opioids. 4
2,3
1 Assistant Professor, Lecturer
This study (double-blind, prospective controlled
1 Department of General Surgery, Faculty of Medicine study) was designed for patients undergoing elective
Menoufia University, Al Minufya, Egypt
laparoscopic cholecystectomy to compare the degree of
2 Department of General Surgery, Faculty of Medicine postoperative pain relief, nausea, and vomiting following
Mansoura University, Mansoura, Egypt
intraperitoneal ropivacaine hydrochloride instillation and
3 Department of Anesthesia, Faculty of Medicine, Ain Shams parenteral analgesia (tramadol).
University, Cairo, Egypt
Corresponding Author: Mahmoud AL Bahram, Assistant MATERIALS AND METHODS
Professor, Department of General Surgery, Faculty of
Medicine, Menoufia University, Minufya, Egypt, Phone: After obtaining written consent, 400 patients with
+0020462228302, e-mail: mahmoudbahreem@yahoo.com
American Society of Anesthesiologists physical status
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