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A randomised, double blinded control study to compare the efficacy of intraperitoneal nebulization and instillation of ropivacaine for postoperative pain relief in patients undergoing laparoscopic appendicectomy

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Original Article

Author Details : Shilpa Masur, Satish Kelageri, Bhagyashri V Kumbar, Archana Endigeri*

Volume : 11, Issue : 3, Year : 2024

Article Page : 395-400

https://doi.org/10.18231/j.ijca.2024.073

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Abstract

Background: Patients scheduled for laparoscopic appendicectomy encounter moderate to severe shoulder pain on the first postoperative day. Intraperitoneal nebulization of local anaesthetics is a new technique which provides uniform spread of local anaesthetic drug particles all through the peritoneum thus providing enhanced analgesic efficacy when compared to intraperitoneal instillation which provides non uniform distribution of the drug.
Materials and Methods: Fifty participants posted for laparoscopic appendicectomy under general anesthesia were randomized into Group A (Intraperitoneal nebulization of 8ml ropivacaine 0.75%) and Group B (intraperitoneal instillation of 8ml ropivacaine 0.75%). Our primary aim was to evaluate analgesic efficacy in both the groups postoperatively. Our secondary objectives were to compare the incidence of shoulder pain post operatively, total 48 hours fentanyl consumption and postoperative complications like nausea & vomiting and paralytic ileus.
Results: There was statistically significance in the pain scores at 24 hours (static pain p=0.003 and dynamic pain p=0.005) & at 48 hours after surgery (static pain p=0.00 and dynamic pain p=0.015). Significant difference was seen in the incidence of shoulder pain. In Group A, no patients complained pain in shoulders while in Group B a maximum of 6 patients complained shoulder pain postoperatively (p=0.022). The total fentanyl consumption over 48 hours was 0.20 ± 0.005 in Group A and 0.80 ± 0.957 in Group B (p = 0.008). Occurrence of postoperative Nausea & Vomiting were similar in both groups. None of the patients complained paralytic ileus in both groups as systemic absorption of the ropivacaine is also considerably less in comparison to other local anaesthetic drugs .
Conclusion: Intraperitoneal nebulized ropivacaine provides greater reduction in postop pain, lesser consumption of opioids, reduction in referred shoulder pain in laparoscopic appendicectomy patients.

Keywords: Intraperitoneal nebulization, Rescue analgesia, Fentanyl, Ropivacaine, Pneumoperitoneum, Laparoscopic appendicectomy

How to cite : Masur S, Kelageri S, Kumbar B V, Endigeri A, A randomised, double blinded control study to compare the efficacy of intraperitoneal nebulization and instillation of ropivacaine for postoperative pain relief in patients undergoing laparoscopic appendicectomy. Indian J Clin Anaesth 2024;11(3):395-400

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