Intraperitoneal ropivacaine with dexamethasone versus ropivacaine alone for pain relief after laparoscopic cholecystectomy: a randomized prospective trial

Background Intraperitoneal instillation of local anesthetics provides effective postoperative pain control after laparoscopic cholecystectomy (LC). This study was aimed to evaluate the analgesic effect and effects on postoperative nausea and vomiting (PONV) of intraperitoneal ropivacaine alone and with dexamethasone in patients undergoing LC. In this randomized, prospective, double-blinded, observational clinical study, a total of 100 patients scheduled for LC were randomized into two equal groups. Group RD (n = 50) received 0.2% ropivacaine 30 ml plus 8 mg dexamethasone, and group RS (n = 50) received 0.2% ropivacaine 30 ml plus 2 ml normal saline intraperitoneally at the end of surgery through the trocar. Pain score was monitored using a numeric rating scale (NRS) at 0, 1, 2, 4, 6, 12, and 24 h postoperatively. The primary objective of the study was to compare the pain intensity between the groups. The secondary objectives were to compare the time to first rescue analgesia, total dose of rescue analgesic in 24 h, incidence of PONV, and side effects if any between the groups.Results A significant difference in mean NRS score was observed among two groups at 6, 12, and 24 h. Only 52% in group RD demanded rescue analgesia as compared to 76% in group RS (P = 0.0004). Incidence of PONV was significantly lower in the RD group than in the RS group. No significant adverse effects were found.Conclusions The addition of 8 mg dexamethasone to intraperitoneal ropivacaine (0.2%) significantly prolongs the time of first rescue analgesic requirement and reduces the total consumption of rescue analgesic in 24 h. It significantly reduces the incidence of PONV in LC as compared to ropivacaine use alone.