Comparison Of Preincisional Port Site Infiltration Of 0.5% Levobupivacaine V/S 0.5% Ropivacaine For Post Operative Pain Relief In Patients Undergoing Laparoscopic Appendicectomy - A One Year Hospital Based Double Blind Randomised Controlled Trial

Abstract

BACKGROUND: It is well known that laparoscopic surgeries cause less post operative pain, allow early ambulation and discharge, than open surgeries. However laparoscopic surgery is not completely pain free. Administration of local anaesthetic into the wound before incision (pre-emptive analgesia) has been found to reduce post operative pain following laparoscopic surgery. Bupivacaine is a commonly used long acting amide local anaesthetic for local infiltration. To overcome the associated cardiotoxicity and neurotoxicity, Levobupivacaine and Ropivacaine which are less cardiotoxic and neurotoxic are being used for local infiltration (port site ) for post operative pain relief. OBJECTIVE: To compare the efficacy of preincisional portsite infiltration of 0.5%Levobupivacaine v/s 0.5% Ropivacaine for post operative pain relief in patients undergoing laparoscopic appendicectomy. METHODOLOGY: The present study was conducted at , KLE'S Dr. Prabhakar Kore Hospital and Medical Research Centre, Nehru nagar, Belagavi 590010, on 60 adult patients undergoing elective laparoscopic appendicectomy under General Anaesthesia between January 2015 to December 2015.Patients were divided into 2 groups, Group 1 and Group 2 by computer generated randomisation table. After induction of general anaesthesia Group 1 patients received 14ml of 0.5% Levobupivacaine preincisional port site infiltration and Group 2 patients received 14ml of 0.5% Ropivacaine preincisional port site infiltration, 6ml at the umbilical port and 4 mL at each working port. Laparoscopic appendicectomy was done according to standard protocol. In the post operative period anaesthesia resident blinded to the drug used assessed for post operative pain at 0, 1,2,3,4,5,6,10,14,18,24 hours using VAS pain scale. If VAS>3 rescue analgesia in the form of Inj Tramadol 2mg/kg was given. Time of first rescue analgesia as well as total opioid consumption at the end of 24hrs was noted. RESULTS: The mean VAS scores were comparable (less than 3) in both the groups at different time intervals post operatively (p > 0.05). The maximum VAS score recorded was 6 at 0th hour in both group1 and group 2. The number of patients requiring rescue analgesia were 5 in group 1 and 6 patients in group 2. The total amount of rescue analgesic consumed over 24 hours in the form of Inj. Tramadol IV was 126 + 14.76 in group 1 and 122+ 12.77 in group 2 and was comparable (p = 0.641). CONCLUSION: Preincisional portsite infiltration with both 0.5% levobupivacaine and 0.5% ropivacaine are equally effective in providing postoperative pain relief in patients undergoing laparoscopic appendicectomy.