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RESEARCH ARTICLE
Effects of Intraperitoneal Instillation of Ropivacaine on

Postoperative Bowel Movements

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MV Ramya , Sudheesh Kannan , Mallikarjuna Manangi , Athish B Shetty , Santhosh Kumar CS
AbstrAct
Background: Gallstone disease represents a significant burden for healthcare systems making laparoscopic cholecystectomy one of the most
common surgical procedures performed in the world.
Aims and objectives: Numerous studies have shown intraperitoneal ropivacaine instillation to have good analgesic effect thus enhancing
postoperative recovery. In this study, we aim to evaluate the effect of intraperitoneal instillation of ropivacaine on postoperative bowel movements.
Methods: A prospective study was conducted on 28 patients undergoing laparoscopic cholecystectomy in the Victoria Hospital, affiliated
to Bengaluru Medical College and Research Institute, Bengaluru, from October 2019 to December 2019. Laparoscopic cholecystectomy was
performed electively on patients diagnosed with symptomatic cholelithiasis. Group A were instilled with ropivacaine intraperitoneally (40 mg of
ropivacaine in 100 mL of normal saline) during laparoscopic cholecystectomy, after the removal of the gallbladder but prior to the removal of the
ports into the gallbladder bed and over the liver surface. Group B were not instilled with any drug. Patients were then monitored postoperatively,
treated with intravenous analgesics, and other supportive care was given. Postoperative bowel movements were then recorded in terms of mean
time for appearance of bowel sounds, passage of flatus, and passage of stools. Patients were then discharged after being deemed fit for discharge.
Results: There was no significant improvement in the return of bowel sounds or in the time to passage of flatus/stools as a result of intraperitoneal
ropivacaine instillation. Further, it did not seem to have a positive effect on the early discharge of patients.
Conclusion: Early recovery from surgery has been a major concern. In this regard, the effect of intraperitoneal instillation of ropivacaine on
postoperative analgesia has been well documented. However, its effect on postoperative bowel movements does not seem to be significant.
Keywords: Cholecystectomy, Enhanced recovery after surgery, Laparoscopic cholecystectomy, Postoperative care.
World Journal of Laparoscopic Surgery (2021): 10.5005/jp-journals-10033-1481

IntroductIon
Gallstone disease represents a significant burden for healthcare 1,3–5 Department of General Surgery, Bangalore Medical College and
systems worldwide and is one of the most common disorders among Research Institute, Bengaluru, Karnataka, India
patients presenting to the general surgery outpatient department 2 Department of Anaesthesiology, Bangalore Medical College and
and emergency with abdominal discomfort. In India, the prevalence Research Institute, Bengaluru, Karnataka, India
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of gallstones ranges from 6 to 9% in the adult population. Autopsy Corresponding Author: Athish B Shetty, Department of General
reports have shown a prevalence of gallstones from 11 to 36%. 2 Surgery, Bangalore Medical College and Research Institute, Bengaluru,
Globally, laparoscopic cholecystectomy is one of the most Karnataka, India, Phone: +91 9901812479, e-mail: shetty.athish@
common surgical procedures performed. Elective laparoscopic gmail.com
cholecystectomy is performed as a day-care procedure in a few How to cite this article: Ramya MV, Kannan S, Manangi M, et al. Effects
hospitals but in most, the hospital stay spans a few days. Several of Intraperitoneal Instillation of Ropivacaine on Postoperative Bowel
factors play a role in this, the primary causes being pain and delayed Movements. World J Lap Surg 2021;14(3):212–214.
return of bowel movements. Several measures including enhanced Source of support: Nil
®
recovery after surgery (ERAS ) protocols have been implemented for Conflict of interest: None
this purpose to hasten the recovery and promote early discharge of
the patient. One of the components of the ERAS protocols includes the
intraperitoneal instillation of ropivacaine in laparoscopic surgeries. 3 divided into two groups. One group received bupivacaine intra-
Clinical trials indicate that ropivacaine is an effective regional peritoneally whereas the other received normal saline. Lesser pain
anesthetic when administered intraperitoneally, providing good was observed in the postoperative period in the group that received
analgesia and thus early postoperative recovery. Ropivacaine is a bupivacaine. 6
long-acting amide local anesthetic agent. It is known to produce Duffield et al. concluded that intraperitoneal instillation of
effects via reversible inhibition of sodium ion influx in nerve fibers. 4 ropivacaine in patients undergoing laparoscopic colectomy
Boddy et al., in their meta-analysis involving 24 randomized decreases postoperative pain and improves functional recovery
controlled trials showed there was a significant postoperative pain thus promoting early discharge. 7
relief after instillation of ropivacaine intraperitoneally in patients Numerous studies have shown that intraperitoneal ropivacaine
who had undergone laparoscopic cholecystectomy. 5 instillation has good analgesic effect thus enhancing postoperative
Chundriger et al. conducted a randomized controlled trial inclu- recovery. In this study, we aim to evaluate the effect of intraperitoneal
ding 60 patients, who underwent laparoscopic cholecystectomy, instillation of ropivacaine on postoperative bowel movements.

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