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Randomised prospective study of using intraoperative, intraincisional and intraperitoneal ropivacaine for the early discharge of post-laparoscopic cholecystectomy patients as a day case in a cost-effective way in government setup of low-income and middle-income countries: Opening new horizons
  1. Singh Mathuria Kaushal-Deep1,
  2. Mehershree Lodhi2,
  3. Afzal Anees1,
  4. Shehtaj Khan1,
  5. Mohammad Amanullah Khan1
  1. 1 Surgery, Jawaharlal Nehru Medical College and Hospital, Aligarh, Uttar Pradesh, India
  2. 2 Anaesthesia, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
  1. Correspondence to Dr Singh Mathuria Kaushal-Deep, Surgery, Jawaharlal Nehru Medical College and Hospital, Aligarh, Uttar Pradesh 202002, India; drkdsm{at}gmail.com

Abstract

Background Pain is the main reason for staying overnight at hospital after an uncomplicated laparoscopic cholecystectomy.

Objectives A randomised prospective study was planned to compare the efficacy of intraincisional and intraperitoneal use of 0.2% ropivacaine so that patients undergoing an uncomplicated laparoscopic cholecystectomy can be discharged as a day case in a cost-effective way.

Methods 191 patients were operated by elective four-port laparoscopic cholecystectomy. They were randomised into three groups after triple blinding according to location of 0.2% ropivacaine use. All patients were given ~23 mL of solution (drug or normal saline depending on the group), 20 mL of which was given at intraperitoneal location and ~1 mL/cm of incision intraincisionally. Pain scores (Visual Analogue Scale (VAS), Numeric Rating Scale (NRS) and Faces Pain Scale-Revised (FPS-R)) were evaluated at 4 and 8 hours postoperatively. Only those patients with a VAS ≤3, NRS ≤3 and FPS-R ≤2, no requirement of rescue analgesia, no shoulder pain, ambulated at least once, passed urine and taking oral sips were offered discharge as a day case.

Results 31% of patients in intraperitoneal group (n=62) could be discharged as a day case as compared with 48% in intraincisional group (n=68) (p>0.05) and 89% in combined group (n=61) (p<0.05, with respect to both other groups).

Conclusion The combined use of intraincisional and intraperitoneal ropivacaine is a cost-effective way of discharging approximately 9 in 10 patients as a day case. This study is unique as this is the first study in which only a local anaesthetic has been used to predict discharges as a day case.

  • ropivacaine
  • local anaesthetic
  • intraincisional infiltration
  • intraperitoneal instillation
  • post-operative pain
  • day case surgery
  • ambulatory surgery
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Footnotes

  • Contributors SMK-D is the principal investigator in this study. He carried out the collection of data, ensuring blinding and randomisation, patient follow-up, pain scoring, statistical analysis and review of literature. ML is the principal anesthetist who helped in the standardisation of anaesthesia so that postoperative pain was not affected by the intraoperative drugs. She also helped in critically reviewing literature regarding the method of use of local anaesthetic and statistical calculations. AA originally conceived of the study, checked all critical steps to ensure standardisation of techniques, was the principal operating surgeon in all the cases, reviewed data collected and gave final approval to the manuscript. SK was the principal operating assistant to the main surgeon. She gave important inputs regarding the technical aspect of the study, conducted literature review and cross-checked statistical calculations. MAK is the senior most surgeon in the team under whose guidance all study was taken out. He gave valuable inputs in streamlining the randomisation, blinding and data collection during the study. He critically reviewed the final manuscript for any factual or technical errors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval was taken from the Ethical Committee of the University.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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