Comparison of post operative analgesia following intraperitoneal instillation of ropivacaine with or without dexamethasone for patients undergoing laparoscopic surgeries





Highlights




  • •

    Laparoscopy benefits: improves cosmesis, speeds up recovery, and decreases hospital stays.


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    Pain management challenge: despite less severe pain, effective control is critical for minimizing analgesic use and hospitalization duration.


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    Consequences of poor pain control: includes higher mortality, chronic pain, delayed recovery, and increased healthcare costs.


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    Local anesthetics importance: essential for reducing postoperative pain and enhancing recovery in abdominal surgeries.


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    Advancements in pain relief: intraperitoneal ropivacaine with dexamethasone improves pain control, reduces rescue medication, and mitigates postoperative nausea and vomiting in laparoscopic surgery.



Abstract


Aim


To analyse how combining ropivacaine with dexamethasone in multimodal analgesia amplifies pain management and decreases postoperative discomfort (including nausea, vomiting, and rescue analgesia use) compared to using ropivacaine alone in patients undergoing laparoscopic surgery, with a focus on improving recovery outcomes.


Results


The initial patient distribution between groups showed no significant difference, our study highlighted substantial differences in key outcomes. Patients receiving multimodal analgesia (ropivacaine with dexamethasone) had significantly less postoperative nausea, vomiting, lower pain scores (VAS), decreased need for rescue analgesia, and longer intervals before requiring additional pain relief compared to those receiving ropivacaine alone.


Conclusion


Combining ropivacaine with dexamethasone for laparoscopic surgery patients gives superior pain relief compared to using ropivacaine alone. This dual approach not only reduces pain more effectively but also reduces nausea, vomiting, and the use of additional pain medication. It aims to enhance postoperative comfort and expedite recovery for patients undergoing these procedures.”


1


Introduction


Laparoscopic surgery has transformed surgical practice with its advantages of minimal invasiveness, faster recovery times, and reduced hospital stays as compared to traditional open procedures. Despite these benefits, effective management of postoperative pain remains crucial for ensuring patient comfort, facilitating early mobilization, and minimizing complications. Inadequate pain control can prolong recovery, increase healthcare costs, and impact patient satisfaction.


Multimodal analgesia has emerged as a preferred approach in perioperative care, combining different analgesic agents to target multiple pain pathways and enhance pain relief while minimizing adverse effects. Among these agents, local anesthetics like ropivacaine, when supplemented with adjuncts such as dexamethasone, have shown improvement in postoperative pain outcomes in various surgical settings.


This study aims to evaluate the efficacy of intraperitoneal ropivacaine with dexamethasone compared to ropivacaine alone in laparoscopic surgery. Specifically, it focuses on outcomes related to postoperative pain intensity, incidence of nausea and vomiting, and the need for rescue analgesia. Understanding these outcomes will not only contribute to optimizing pain management strategies but also potentiate recovery experiences and overall patient outcomes in laparoscopic surgery.


2


Materials and methods


This prospective randomized controlled study was conducted at a tertiary care hospital following approval from the Institutional Ethics Committee (ICE Approval No.: VMMC/ANAES/2021/53) and in accordance with the principles outlined in the Declaration of Helsinki (2013). The study enrolled a total of 60 patients aged between 18 and 60 years who were scheduled for various laparoscopic surgeries. Patients were carefully screened and included if they met ASA physical status classification I or II, indicating generally healthy individuals. Exclusion criteria comprised patients with ASA III or IV status, known drug allergies, indications requiring conversion to open surgery during the procedure, the need for abdominal drainage post-surgery, inability to communicate using the Visual Analogue Scale (VAS) for pain assessment, presence of mental illness, or refusal to participate in the study.


Participants were randomly assigned to one of two groups:



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    Group RS (Ropivacaine alone): Received intraperitoneal ropivacaine 0.75 % (13.5 ml) diluted with 36.5 ml of normal saline.


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    Group RD (Ropivacaine with Dexamethasone): Received intraperitoneal ropivacaine 0.75 % (13.5 ml) diluted with 36.5 ml of normal saline and dexamethasone 16 mg (4 ml).



Anesthesia management was standardized across both groups and involved preoperative placement of an intravenous catheter (18-gauge) for fluid administration, including crystalloid solutions at a rate of 6 ml/kg/h. Anesthesia induction was achieved with intravenous fentanyl (2 micrograms/kg), propofol (2.0–2.5 mg/kg), and atracurium (0.5 mg/kg) to facilitate endotracheal intubation. Anesthesia maintenance was maintained with a mixture of 50 % nitrous oxide in oxygen and 2–3 % sevoflurane, with intermittent boluses of atracurium to maintain muscle relaxation throughout the procedure. Monitoring included continuous electrocardiography (ECG), non-invasive blood pressure, oxygen saturation (SpO2), and end-tidal carbon dioxide (EtCO2).


Intraperitoneal study solutions were instilled through the trocar ports before abdominal closure at the conclusion of surgery. Postoperatively, patients were transferred to the post-anesthesia care unit (PACU) where pain intensity was assessed using the VAS at regular intervals (0.5, 2, 6, 12, and 24 h). Rescue analgesia, consisting of intravenous tramadol (100 mg), was administered to patients with VAS scores exceeding 4. Postoperative nausea and vomiting were managed with intravenous ondansetron (4 mg) as needed.


The primary outcome of the study was the assessment of postoperative pain intensity using the VAS score, both at specific time intervals and as an overall average score. Secondary outcomes included the total amount of rescue analgesia used, incidence of nausea and vomiting, and any adverse effects associated with the study interventions. Statistical analysis was performed to compare outcomes between the two groups, aiming to evaluate the efficacy of combining dexamethasone with ropivacaine in enhancing postoperative pain management and improving recovery outcomes in laparoscopic surgery patients.


3


Theory and calculation


Data Coding and Entry: All data were coded and entered into Microsoft Excel for organization and initial analysis, ensuring accuracy through double-checking procedures.


Data Analysis: Quantitative data, such as pain scores (mean and SD), and categorical variables (percentage and frequency) like nausea and vomiting rates, were analyzed using SPSS version 22.


Statistical Tests: The independent sample t -test assessed mean differences between Group RS (ropivacaine alone) and Group RD (ropivacaine with dexamethasone). Fisher’s Exact Test and Pearson Chi-Square Test compared categorical variables. A p-value < 0.05 indicated statistical significance.


Visualization: Data were visually presented with pie charts, bar diagrams, tables, and figures to illustrate variable distribution and group differences.


Statistical Significance: A p-value < 0.05 was considered significant, suggesting that dexamethasone and ropivacaine may improve pain management and decrease complications in laparoscopic surgery patients.


4


Results


Table 1 shows the age and gender of patients allocatedundergroup RS and RD alongwith the weight of the patients and ASA grading. Thirteen(43.3 %)patients were female and seventeen (56.7 %)patients were male in RS group.Similarly,inthe RDgroup,18(60 %)patients were female and 12 (40 %) patients were male. Out of 30 (100 %) patients from RS, 16 (53.3 %) patients were ASA grade I and14(46.7 %)patientswere ASAgrade II.Furthermore,out of30(100 %) patients from RD,20(66.7 %)patients were ASA grade I and 10(33.3 %)patients were ASA grade II.There was no statistically significant difference observed based on the distribution of patients into both the study groups.



Table 1

Demographical profile.





























Variables Group RS (N = 30) Group RD (N = 30) P Value
Age 41.10±12.46 12.46±9.34 0.700
Gender (Male/Female) 17/13 12/18
Weight 64.50 ± 8.89 63.17 ± 9.04 0.567
ASAI/II 16/14 20/10


Table 2 : shows the Visual Analogue Scale(VAS)Score which study the variables median of VAS at 05 hrs in the RS group was recorded as 3(3–4) and RD group was recorded as 2.5(2–3). Additionally, the p-value 0.002 revealed that there are high significance differences between the groups. The variables median of VAS score at 12 hrs in the RS group was recorded as 2.5(2–3)and RD group was recorded as 2.5(2–3),the p-value 0.003 revealed that there are high significance differences between groups. The variables median of VAS24 hrs in the RS group was recorded as2(2–2) and RD group was recorded as1.5(1–2) with the p-value 0.001 revealed that there is high significance differences between groups. The variables median of VAS 2 hrs and VAS 6 hrs were not showing any significant differences.


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May 22, 2025 | Posted by in ANESTHESIA | Comments Off on Comparison of post operative analgesia following intraperitoneal instillation of ropivacaine with or without dexamethasone for patients undergoing laparoscopic surgeries

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