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Intraperitoneal Instillation of Ropivacaine and Postoperative Bowel Movements
It is also clear from Figure 2 that passage of flatus was early in conclusIon
the group that did not receive ropivacaine. The p-value, however,
was again >0.05 and hence requiring more studies to show a Early recovery from surgery has been a major concern. In this
statistically significant result. regard, the effect of intraperitoneal instillation of ropivacaine on
postoperative analgesia has been well documented. However,
the effect of the same on postoperative bowel movements does
dIscussIon not seem to be significant. Hence, further studies are needed to
Laparoscopic cholecystectomy is one of the most common validate our results.
surgeries performed worldwide. In this era, when people wish to
resume work as early as possible following a surgery, new steps are orcId
3
being taken to enhance postoperative recovery. MV Ramya https://orcid.org/0000-0001-6412-6970
Enhanced recovery after surgery (ERAS) protocols are being Sudheesh Kannan https://orcid.org/0000-0002-3341-538X
implemented in this regard. One of the components of the ERAS
protocol for laparoscopic surgeries includes intraperitoneal Mallikarjuna Manangi https://orcid.org/0000-0002-1509-8501
instillation of ropivacaine for its regional anesthetic effect, thus Athish B Shetty https://orcid.org/0000-0002-7796-9341
reducing postoperative pain and promoting early discharge of Santhosh Kumar CS https://orcid.org/0000-0003-4656-9465
the patient. 3
Several studies have shown the positive effects of intraperitoneal references
instillation of ropivacaine on postoperative pain with barely any 1. Unisa S, Jagannath P, Dhir V, et al. Population-based study to estimate
side effects. prevalence and determine risk factors of gallbladder diseases in the
A prospective randomized control study conducted by Shivhare rural Gangetic Basin of North India. HPB (Oxford) 2011;13:117–125.
et al. concluded that 0.5% of 30 mL (150 mg) of ropivacaine Available from: https://dx.doi.org/10.1111%2Fj.1477-2574.2010.00255.x.
instilled intraperitoneally in patients undergoing laparoscopic 2. Pham TH, Hunter JG. Gallbladder and the extrahepatic biliary system.
cholecystectomy significantly reduced the shoulder tip pain during In: Brunicardi FC, Andersen DK, Billiar TR, Dunn DL, Hunter JG,
the first postoperative day compared with 30 mL of normal saline Matthews JB, et al. Eds. Schwartz’s principles of surgery. 10th edition.
New York: McGraw-Hill; 2015:1309–1340. NLMID: 101614128.
instilled in the gallbladder fossa. 8 3. Kehlet H. Multimodal approach to control postoperative
Wu et al. conducted a study in 2005 in which they concluded pathophysiology and rehabilitation. Br J Anaesth 1997;78:606–617.
that perioperative cotreatment with dextromethorphan and DOI: 10.1093/bja/78.5.606.
intravenous lidocaine had better analgesic effect and promotes 4. Kuthiala G, Chaudhary G. Ropivacaine: a review of its pharmacology
early recovery of bowel function after laparoscopic cholecys- and clinical use. Indian J Anaesth 2011;55(2):104–110. DOI:
tectomy. 9 10.4103/0019-5049.79875.
Elhakim et al. concluded in their study that a combination of 5. Boddy AP, Mehta S, Rhodes M. The effect of intra-peritoneal local
intraperitoneal instillation of lidocaine and tenoxicam provided anaesthetic in laparoscopic cholecystectomy : a systemic review
and meta-analysis. Anesth Analg 2006;103(30):682–688. DOI: 10.1213/
better analgesia and faster return of bowel function. 10 01.ane.0000226268.06279.5a.
However in our study, it was noted that intraperitoneal 6. Chundrigar T, Hedges AR, Morris R, et al. Intraperitoneal bupivacaine
instillation of ropivacaine had no significant effect on bowel for effective pain relief after laparoscopic cholecystectomy. Ann R
movements. Coll Surg Engl 1993;75(6):437–439. PMID: 8285548.
Though there are studies observing the analgesic effect there is 7. Duffield JA, Thomas ML, Moore JW, et al. Intraperitoneal local
a lack of literature studying the effects of intraperitoneal instillation anesthetic instillation and postoperative infusion improves
of ropivacaine on bowel movements. functional recovery following colectomy: a randomized controlled
In our study, this hypothesis was studied to know the possible trial. Dis Colon Rectum 2018;61(10):1205–1216. DOI: 10.1097/
DCR.0000000000001177.
effects of intraperitoneal instillation of ropivacaine on bowel 8. Shivhare P, Dugg P, Singh H, et al. A prospective randomized trial
movements. It was noted that there was no significant improvement to study the effect of intraperitoneal instillation of ropivacaine in
in the return of bowel sounds or in the time to passage of flatus/ postoperative pain reduction in laparoscopic cholecystectomy.
stools. It also did not seem to have a positive effect on the early J Minim Invasive Surg Sci 2014;3(4):e189. PMID: 29962601.
discharge of patients. 9. Wu CT, Borel C, Lee MS, et al. The Interaction effect of Perioperative
cotreatment with dextromethorphan and intravenous lidocaine
on pain relief and recovery of bowel function after laparoscopic
lIMItAtIons of the study cholecystectomy. Anesth Analg 2005;100(2):448–453. DOI: 10.1213/
01.ANE.0000142551.92340.CC.
As the study was conducted on a smaller population, generalizing 10. Elhakim M, Amine H. Effects of intraperitoneal lidocaine combined
these results to a bigger population might not be appropriate and with intravenous or intraperitoneal tenoxicam on pain relief and bowel
further studies would be needed to have a definite picture of the recovery after laparoscopic cholecystectomy. Acta Anaesthesiol
effect of ropivacaine on postoperative bowel movements. Scand 2000;44(8):929–933. DOI: 10.1034/j.1399-6576.2000.440806.x.

214 World Journal of Laparoscopic Surgery, Volume 14 Issue 3 (September–December 2021)