A COMPARISON OF POST-OPERATIVE PAIN RELIEF AFTER ELECTIVE LSCS WITH LOCAL AND INTRAPERITONEAL ROPIVACAINE INSTILLATION AGAINST LOCAL ROPIVACAINE INFILTRATION ALONE

Authors

  • SONALI TRIPATHI Department of Anaesthesiology, Chhindwara Institute of Medical Sciences, Chhindwara, Madhya Pradesh, India.
  • SANDEEP THAKRE Department of General Surgery, Chhindwara Institute of Medical Sciences, Chhindwara, Madhya Pradesh, India.
  • NIDHI NARREY Department of Obstetrics and Gynecology, Chhindwara Institute of Medical Sciences, Chhindwara, Madhya Pradesh, India.
  • DILEEP DANDOTIYA Department of Community Medicine, Chhindwara Institute of Medical Sciences, Chhindwara, Madhya Pradesh, India.
  • PUJA SINGH Department of Pathology, Bundelkhand Medical College, Sagar, Madhya Pradesh, India.
  • AMIT KUMAR JAIN Department of Anaesthesiology, SSH, NSCB Medical College, Jabalpur, Madhya Pradesh, India.

DOI:

https://doi.org/10.22159/ajpcr.2023.v16i4.47694

Keywords:

Spinal anesthesia, Ropivacaine, Local infiltration, Intraperitoneal instillation

Abstract

Objectives: For an anesthesiologist, the post-operative phase is just as crucial as the pre-operative and intraoperative periods. Whether a surgery is performed under regional or general anesthesia, the goal should always be to provide patients with a pain-free and comfortable recovery. Spinal anesthesia is frequently used during caesarean sections, but its effects only last for a few hours. As a result, various multidisciplinary analgesia strategies with few side effects have been attempted for postpartum patients to relieve pain because they may also be harmful to the newborn baby’s health. It has already been proven; injecting ropivacaine is a far safer alternative to injecting bupivacaine. We compared local infiltration of injectable ropivacaine alone to both intraperitoneal instillation and local infiltration for post-operative analgesia in individuals who had cesarean surgery. In the present study, intraperitoneal instillation and local infiltration of ropivacaine 0.5% were compared to local infiltration of ropivacaine 0.5% alone for the management of post-operative pain following elective cesarean section under spinal anesthesia.

Methods: Pregnant women in ASA Grades I and II who were having a planned caesarean section under spinal anesthesia were divided into two groups at random (R1 and R2 group, each have 30 patients). Patients in Group R1 received a 15 mL injection of 0.5% ropivacaine at the incision site. Patients in Group R2 had intraperitoneal injections of 0.5% ropivacaine in 5 mL before to peritoneal closure and local infiltrations of 10 mL ropivacaine at the site of the incision before skin closure. The duration of the analgesia was calculated by timing the start of the sensory block to a point at which rescue analgesia was sought throughout the post-operative period. Pain intensity was measured using the visual analog scale (VAS). Data on the hemodynamics and side effects of the patients were also gathered.

Results: Group R2 analgesia lasted much longer than that of Group R1 (p<0.05). The mean (±SD) analgesic duration in the R1 and R2 groups was 147.17±4.67 and 170.33±3.69 min, respectively. The mean (SD) VAS scores for Group R1 and Group R2 at the moment of the first analgesic demand were 36.7±5.14 and 32.6±6.52, respectively.

Conclusion: When combined with intraperitoneal instillation during spinal anesthesia, inj. ropivacaine 0.5% local infiltration enhances post-operative analgesia in cesarean section procedures.

Downloads

Download data is not yet available.

References

Nguyen NK, Landais A, Barbaryan A, M’Barek MA, Benbaghdad Y, McGee K, et al. Analgesic efficacy of Pfannenstiel incision infiltration with ropivacaine 7.5 mg/mL for caesarean section. Anesthesiol Res Pract 2010;2010:542375. doi: 10.1155/2010/542375, PMID 20721290

Dinic V, Savic N, Markovic D, Stojanovic M, Veselinovic I, Stosic B. Anesthesia for cesarean section and postoperative analgesia for the parturient. Acta Med Mediterr 2015;54:72-8.

Khan ZH, Karvandian K, Maghsoudloo M, Albareh H. The role of opioids and non-opioids in postoperative pain relief; a narrative review. Arch Anesthcrit Care 2018;4:430-5.

Sun JX, Bai KY, Liu YF, Du G, Fu ZH, Zhang H, et al. Effect of local wound infiltration with ropivacaine on postoperative pain relief and stress response reduction after open hepatectomy. World J Gastroenterol 2017;23:6733-40. doi: 10.3748/wjg.v23.i36.6733, PMID 29085218

Werawatganon T, Charuluxanun S. Patient-controlled intravenous opioid analgesia versus continuous epidural analgesia for pain after intra-abdominal surgery. Cochrane Database Syst Rev 2005;1:CD004088. doi: 10.1002/14651858.CD004088.pub2, PMID 15674928

Rezai S, Patel ND, Hughes AC. Cesarean delivery under local anesthesia: A literature review. Obstet Gynecol Int J 2018;9:175-8.

Li YM, Wingrove DE, Too HP, Marnerakis MB, Stimson ER, Strichartz GR, et al. Local anesthetics inhibit substance P binding and evoked increases in intracellular calcium sup 2. Anesthesiology 1995;82:166-73. doi: 10.1097/00000542-199501000-00021, PMID 7530414

Amir R, Argoff CE, Bennett GJ, Cummins TR, Durieux ME, Gerner P, et al. The role of sodium channels in chronic inflammatory and neuropathic pain. J Pain 2006;7(Suppl 3):S1-29. doi: 10.1016/j. jpain.2006.01.444, PMID 16632328

Ganta R, Samra SK, Maddineni VR, Furness G. Comparison of the effectiveness of bilateral ileoinguinal nerve block and wound infiltration for postoperative analgesia after cesarean section. Br J Anaesth 1994;72:229-30. doi: 10.1093/bja/72.2.229

Labaille T, Mazoit JX, Paqueron X, Franco D, Benhamou D. The clinical efficacy and pharmacokinetics of intraperitoneal ropivacaine for laparoscopic cholecystectomy. Anesth Analg 2002;94:100-5. doi: 10.1097/00000539-200201000-00019, PMID 11772809

Gautam A, Muzalda B, Tandon N. Ropivacaine hydrochloride 0.2% local infiltration and intraperitoneal instillation for postoperative pain relief in the cesarean section under spinal anesthesia: A randomized clinical study. J Evol Med Dent Sci 2016;5:5816-9. doi: 10.14260/ jemds/2016/1312

Yong L, Guang B. Intraperitoneal ropivacaine instillation versus no intraperitoneal ropivacaine instillation for laparoscopic cholecystectomy: A systematic review and meta-analysis. Int J Surg 2017;44:229-43. doi: 10.1016/j.ijsu.2017.06.043, PMID 28669869

Kaushal-Deep SM, Lodhi M, Anees A, Khan S, Khan MA. Randomised prospective study of using intraoperative, intraincisional, and intraperitonealropivacaine 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. Postgrad Med J 2019;95:78-84. doi: 10.1136/postgradmedj-2018-135662, PMID 31015318

Mulroy MF, Burgess FW, Emanuelsson BM. Ropivacaine 0.25% and 0.5%, but not 0.125%, provide effective wound infiltration analgesia after outpatient hernia repair, but with sustained plasma drug levels. Reg Anesth Pain Med 1999;24:136-41. doi: 10.1097/00115550- 199924020-00007

Bamigboye AA, Justus HG. Ropivacaine abdominal wound infiltration and peritoneal spraying at cesarean delivery for preemptive analgesia. Int J Gynaecol Obstet 2008;102:160-4. doi: 10.1016/j.ijgo.2008.03.019, PMID 18538773

Goldstein A, Grimault P, Henique A, Keller M, Fortin A, Darai E. Preventing postoperative pain by local anesthetic instillation after laparoscopic gynecologic surgery: A placebo-controlled comparison of bupivacaine and ropivacaine. Anesth Analg 2000;91:403-7. doi: 10.1097/00000539-200008000-00032, PMID 10910857

Vinson-Bonnet B, Coltat JC, Fingerhut A, Bonnet F. Local infiltration with ropivacaine improves immediate postoperative pain control after hemorrhoidal surgery. Dis Colon Rectum 2002;45:104-8. doi: 10.1007/ s10350-004-6121-4, PMID 11786772

Callesen T, Hjort D, Mogensen T, Schouenborg L, Nielsen D, Reventlid H, et al. Combined field block and i.p. instillation of ropivacaine for pain management after laparoscopic sterilization. Br J Anaesth 1999;82:586-90. doi: 10.1093/bja/82.4.586, PMID 10472228

Dreher JK, Nemeth D, Limb R. Pain relief following day-case laparoscopic tubal ligation with intra-peritoneal ropivacaine: A randomized double-blind control study. Aust N Z J Obstet Gynaecol 2000;40:434-7. doi: 10.1111/j.1479-828x.2000.tb01176.x, PMID 11194431

Kim TH, Kang H, Park JS, Chang IT, Park SG. Intraperitoneal ropivacaine instillation for postoperative pain relief after laparoscopic cholecystectomy. J Korean Surg Soc 2010;79:130-6. doi: 10.4174/ jkss.2010.79.2.130

Malhotra N, Roy K, Chanana C, Kumar S. Post-operative pain relief after operative gynecological laparoscopic procedures with intraperitoneal bupivacaine. Int J Gynecolobstet 2005;5:1-4.

Ducarme G, Sillou S, Wernet A, Davitian C, Poujade O, Ceccaldi PF, et al. Single-shot ropivacaine wound infiltration during the cesarean section for postoperative pain relief. Gynecolobstet Fertil 2012;40:10-3.

Published

07-04-2023

How to Cite

TRIPATHI, S., S. THAKRE, N. NARREY, D. DANDOTIYA, P. SINGH, and A. K. JAIN. “A COMPARISON OF POST-OPERATIVE PAIN RELIEF AFTER ELECTIVE LSCS WITH LOCAL AND INTRAPERITONEAL ROPIVACAINE INSTILLATION AGAINST LOCAL ROPIVACAINE INFILTRATION ALONE”. Asian Journal of Pharmaceutical and Clinical Research, vol. 16, no. 4, Apr. 2023, pp. 18-20, doi:10.22159/ajpcr.2023.v16i4.47694.

Issue

Section

Original Article(s)

Most read articles by the same author(s)

<< < 1 2