Background : Although Laparoscopic cholecystectomy (LC) is minimally invasive with less morbidity, postoperative pain remains a significant burden to health care. Various pharmacological and non-pharmacological interventions have been tried to reduce the postoperative pain. In this study, we compared the efficacy of intraperitoneal nebulization with the instillation of ropivacaine in decreasing postoperative pain after LC.

Methods : The study was single-center, double-blinded, RCT. Fifty-six patients were randomized to receive intraperitoneal nebulization or instillation of ropivacaine. Static, dynamic, and shoulder pain were measured using a visual analog scale (VAS) at 6, 24, and 48 hours after surgery. Also, time to unassisted walking, postoperative nausea and vomiting (PONV), and postoperative length of hospital stay (PLOH) were measured.

Results : The static pain at 6,24 and 48 hours (p-0.007, 0.016, 0.04) and Dynamic pain up to 24 hours (p-0.002, 0.026) were significantly lower in the nebulization group. Patients in the nebulization group had decreased postoperative vomiting (p-0.023) and ambulated early (p-0.003). There was no statistically significant difference in shoulder pain (p-0.87, 0.69, 0.32), incidence of nausea (p-0.076) & PLOH (p-0.48) between the groups.

Conclusions : Intraperitoneal nebulization of ropivacaine results in decreased postoperative pain, time to unassisted walking, and the incidence of postoperative vomiting when compared to intraperitoneal instillation of ropivacaine in patients undergoing laparoscopic cholecystectomy.