Objective and Aim: Post-caesarean section pain is associated with significant morbidity. Intraperitoneal instillation of local anaesthetics has been a promising technique to minimise the postoperative pain. The aim of our study was to evaluate the relative efficacy of Bupivacaine and Ropivacaine for postoperative analgesia in elective caesarean section in relation to duration of postoperative analgesia and complications.

Materials & Methods: In this study, 90 patients of ASA GradeⅠand Ⅱ undergoing elective caesarean section were divided into 3 groups after randomization to receive intraperitoneal instillation of 30ml Normal saline 0.9% in group C, 30ml Bupivacaine 0.25% in group B and 30ml Ropivacaine 0.25% in group R at the end of uterine closure. All patients were assessed for postoperative pain using VAS score at 0, 2,4,6,12 and 24hrs. Rescue analgesic was given when VAS score was > 6. The timing of the first dose of rescue analgesic and the total requirement of rescue analgesia in the first 24 hrs was noted.

Results: The time for the first rescue analgesic requirement was significantly longer in group R (7.28 hrs) compared to group B(4 hrs) and group C(2.5 hrs) with p value of 0.001. The total consumption of rescue analgesic drug was more in group C (275mg) and group B(172mg) as compared to group R(92mg) with p value of 0.0001.

Conclusion: We conclude that when compared to bupivacaine, intraperitoneal instillation of Ropivacaine not only provides superior analgesia but also reduces the total rescue analgesic dose consumption without any significant adverse effects in an elective caesarean section.

Keywords: Intraperitoneal instillation, Bupivacaine, Ropivacaine, postoperative analgesia.

1. Carvalho B, Cohen SE, Lipman SS, Fuller A, Mathusamy AD, Macario A(2005). Patient preference for anaesthesia outcomes with caesarean delivery. Anaesthesia and analgesia 2005;10 (14);1182-1187.
2. Eisenach JC, Pan PH, Smiley R, Lavand' homme P, Landau R, Houle TT (2008). Severity of acute pain after childbirth but not type of delivery,predicts persistant pain and postpartum depression. Pain.2008 nov 15;140 (1) 87-94.
3. Luana Buhagiar, Olivia A Cassar,  Mark P Brincat, George G Buttigieg,  Anthony Serracino Inglott,  Maurice Zarb Adami,  Lilian M Azzopardi (2011) predictors of post caesarean section pain and analgesic consumption. J Anaesthesiol Clin Pharmacol 2011;27:185-91.
4. Goldstein Andrei; Grimault Patrick ; Henique Aude ; Keller Michèle ; Fortin Anne ; Darai Emile (2000). Preventing Postoperative Pain by Local Anesthetic Instillation After Laparoscopic Gynecologic Surgery: A Placebo-Controlled Comparison of Bupivacaine and Ropivacaine. Anesthesia & Analgesia: August 2000 - Volume 91 - Issue 2 - p 403–407.
5. Roberts K, Gilmour J, Pande R, Nightingle P Tan L et al (2011). Efficacy of intraperitoneal local anaesthetic techniques during laparoscopic cholecystectomy. Surgical Endoscopy and Other Interventional Techniques 2011 nov;25 (11);3695-705.
6. Labaille, Thierry ; Mazoit, Jean Xavier ; Paqueron, Xavier ; Franco, Dominique Benhamou, Dan (2002).The clinical efficacy and pharmacokinetics of intraperitoneal ropivacaine for laparoscopic cholecyst-ectomy. Anesthesia & Analgesia: January 2002 - Volume 94 - Issue 1 - p 100–105
7. Sunil Chiruvella,  Srinivasa Rao Nallam (2016). Intraperitoneal instillation of ropivacaine plus dexmedetomidine for pain relief after laparoscopic hysterectomy: A comparison with ropivacaine alone. J NTR Univ Health Sci 2016;5:93-7
8. Kucuk, C., Kadiogullari, N., Canoler, O., & Savlı, S. (2007). A Placebo-Controlled Comparison of Bupivacaine and Ropivacaine Instillation for Preventing Postoperative Pain After Laparoscopic Cholecystectomy. Surgery Today, 37(5), 396-400.
9. Ahmed BH, Ahmed A, Tan D, Awad ZT, Al-Aali AY, Kilkenny J, et al. Post-laparoscopic cholecystectomy pain: effects of intraperitoneal local anaesthetics on pain control—a randomized prospective double-blinded placebo-controlled trial. Am Surg. 2008;74(3):201–09.
10. Saad Ei Basha, Maha G Hanna, Sherif M Soaida, Hagar H Rafaee. Intraperitoneal instillation of l-bupivacaine in laparoscopic pediatric procedures: a randomized - controlled study. Ain-Shams Journal of Anaesthesiology8(2), 247, 2015.
11. Donatsky AM, Bjerrum F, Gögenur I. Intraperitoneal instillation of saline and local anaesthesia for prevention of shoulder pain after laparoscopic cholecystectomy: a systematic review. Surg Endosc. 2013;27(7):2283–92.
12. Babu R, Jain P, Sherif L. Intraperitoneal instillation: ropivacaine vs bupivacaine for post operative pain relief in laparoscopic cholecystectomy. Int J Health Sci Res. 2013;3(12):42-47.
13. Devalkar PS, Salgaonkar SV. Intraperitonneal instillation of 0.25% bupivacaine for laparoscopic cholecystectomy: Effect on postoperative pain. IJCMAAS.2016;12;91-5.
14. Narchi P, Benhamou D, Fernandez H. Intraperitoneal local anaesthetic for shoulder pain after day-case laparoscopy. 1991;338:1569–70.
15. Sharan R, Singh M, Kataria AP, Jyoti K, Jarewal V, Kadian R. Intraperitoneal Instillation of Bupivacaine and Ropivacaine for Postoperative Analgesia in Laparoscopic Cholecystectomy. Anesth Essays Res. 2018;12(2):377-380.

Dr Richa Soni

Resident, Department of Anaesthesia, Sardar Patel Medical College & AGH, Bikaner, Rajasthan

Email: This email address is being protected from spambots. You need JavaScript enabled to view it.