Comparison between Ropivacaine and Bupivacaine Instillation into Peritoneal cavity to Reduce Post-operative Pain after Laparoscopy in Infertile Women: Randomized Controlled Trial

Abstract

ynecological laparoscopy is now becoming a more popular technique for diagnosis and treatment of infertility cases. Post operative pain after gynecological laparoscopy may be due to small incision in abdominal wall or as a result of diaphragmatic irritation by inflating gases. Both Ropivacaine and bupivacaine were effective in prevention of pain and PONV at wake-up and over the first 12 h after laparoscopic gynaecologic surgery when intra-peritoneally instilled at the end of laparoscopy Patients were divided into two main groups then each group was sub divided into two groups. At end of surgery local anaethetic was instilled intraperitioneal under direct vision and position of the patient was changed to reversed trendlenberg position for 15 minutes. All patients had been subjected to monitoring of heamodynamics with postoperative assessment of pain score (prince-Henry score 0-5), nausea and vomiting The results of this study showed that administration of 20mL of Bupivacaine 0.25% at the end of technique gave pain relief for three hours in group A1 and pain relief for two hours in group A2, associated with an increase in heart rate and blood pressure for one hour in group A1 and A2 for two hours. The Incidence of associated side effects (nausea, vomiting) in group A1 was 8.1% and in group A2 was 11.1%. The results of this study showed that administration of 20mL of Ropivacaine 0.75% at the end of technique gave pain relief for four hours in group B1 and pain relief for three hours in group B2, associated with an increase in heart rate and blood pressure for two hours in group B1 and B2 for three hours. The Incidence of associated side effects (nausea, vomiting) in group B1 was 10.8% and in group B2 was 16.7%.

CONCLUSION AND RECOMMENDATION T he study concluded that instillation of local anaethetic after laparoscopy gave better pain relief post operatively and minimized the patient staying time in the hospital. Administration of 20 mL of 0.25% of bupivacaine by intra-peritoneal Instillation gave pain relief for three hours in group A1, and for two hours in group A2. Administration of 20 mL of 0.75% of ropivacaine by intra-peritoneal instillation gave pain relief for four hours in group B1, and for three hours in group B2. Further more studies on large scales with use of larger volumes and higher concentrations of Bupivacaine and ropivacaine are recommended.