Levo-Bupivacaine vs. Ropivacaine for Post-Operative Pain Relief after Pre-Emptive Intraperitoneal Instillation in Laparoscopic Appendicectomy

Introduction: Pain in the immediate postoperative period is found to be less after laparoscopic than after conventional surgical techniques. Ropivacaine is often in favour of Bupivacaine to avoid the risks of toxicity. Levo-bupivacaine, a safer version of bupivacaine is a contender to Ropivacaine. We compare the pain relief provided by Ropivacaine and Levo-bupivacaine instilled intra-abdominally during laparoscopic surgery for acute appendicitis. Methods and material: This is a double blinded randomized placebocontrolled study conducted on 120 patients in a public hospital over a period of 10 months. Using patient control analgesia (PCA), amount of morphine utilized to attain pain scores of 0-1, measured using visual analog score (VAS) was compared among placebo, Ropivacaine and Levo-bupivacanie group. Results: Data was analysed using analysis of variance with post-hoc multiple comparisons using Bonferroni test and statistical significance was set at p < 0.05. No significant difference was noted between the Ropivacaine and Levo-bupivacaine groups (p = 1); utilization of morphine was similar for both drugs. However, significant difference was noted between placebo and local anaesthetics (p = 0). Conclusions: There appear to be no difference between Ropivacaine and Levo-bupivacaine in terms of pain relief though Ropivacaine has been indicated to be less potent than Bupivacaine in some studies. Pre-emptive instillation of local anaesthetic for laparoscopic surgery is beneficial for post-operative pain relief. OriginAl ArTicle