World Journal of Laparoscopic Surgery

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VOLUME 14 , ISSUE 3 ( September-December, 2021 ) > List of Articles


Effects of Intraperitoneal Instillation of Ropivacaine on Postoperative Bowel Movements

MV Ramya, Sudheesh Kannan, Mallikarjuna Manangi, Athish B Shetty, CS Santhosh Kumar

Keywords : Cholecystectomy, Enhanced recovery after surgery, Laparoscopic cholecystectomy, Postoperative care

Citation Information : Ramya M, Kannan S, Manangi M, Shetty AB, Kumar CS. Effects of Intraperitoneal Instillation of Ropivacaine on Postoperative Bowel Movements. World J Lap Surg 2021; 14 (3):212-214.

DOI: 10.5005/jp-journals-10033-1481

License: CC BY-NC 4.0

Published Online: 05-03-2022

Copyright Statement:  Copyright © 2021; The Author(s).


Background: Gallstone disease represents a significant burden for healthcare systems making laparoscopic cholecystectomy one of the most common surgical procedures performed in the world. Aims and objectives: Numerous studies have shown intraperitoneal ropivacaine instillation to have good analgesic effect thus enhancing postoperative recovery. In this study, we aim to evaluate the effect of intraperitoneal instillation of ropivacaine on postoperative bowel movements. Methods: A prospective study was conducted on 28 patients undergoing laparoscopic cholecystectomy in the Victoria Hospital, affiliated to Bengaluru Medical College and Research Institute, Bengaluru, from October 2019 to December 2019. Laparoscopic cholecystectomy was performed electively on patients diagnosed with symptomatic cholelithiasis. Group A were instilled with ropivacaine intraperitoneally (40 mg of ropivacaine in 100 mL of normal saline) during laparoscopic cholecystectomy, after the removal of the gallbladder but prior to the removal of the ports into the gallbladder bed and over the liver surface. Group B were not instilled with any drug. Patients were then monitored postoperatively, treated with intravenous analgesics, and other supportive care was given. Postoperative bowel movements were then recorded in terms of mean time for appearance of bowel sounds, passage of flatus, and passage of stools. Patients were then discharged after being deemed fit for discharge. Results: There was no significant improvement in the return of bowel sounds or in the time to passage of flatus/stools as a result of intraperitoneal ropivacaine instillation. Further, it did not seem to have a positive effect on the early discharge of patients. Conclusion: Early recovery from surgery has been a major concern. In this regard, the effect of intraperitoneal instillation of ropivacaine on postoperative analgesia has been well documented. However, its effect on postoperative bowel movements does not seem to be significant.

  1. Unisa S, Jagannath P, Dhir V, et al. Population-based study to estimate prevalence and determine risk factors of gallbladder diseases in the rural Gangetic Basin of North India. HPB (Oxford) 2011;13:117–125. Available from:
  2. Pham TH, Hunter JG. Gallbladder and the extrahepatic biliary system. In: Brunicardi FC, Andersen DK, Billiar TR, Dunn DL, Hunter JG, Matthews JB, et al. Eds. Schwartz's principles of surgery. 10th edition. New York: McGraw-Hill; 2015:1309–1340. NLMID: 101614128.
  3. Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth 1997;78:606–617. DOI: 10.1093/bja/78.5.606.
  4. Kuthiala G, Chaudhary G. Ropivacaine: a review of its pharmacology and clinical use. Indian J Anaesth 2011;55(2):104–110. DOI: 10.4103/0019-5049.79875.
  5. Boddy AP, Mehta S, Rhodes M. The effect of intra-peritoneal local anaesthetic in laparoscopic cholecystectomy: a systemic review and meta-analysis. Anesth Analg 2006;103(30):682–688. DOI: 10.1213/01.ane.0000226268.06279.5a.
  6. Chundrigar T, Hedges AR, Morris R, et al. Intraperitoneal bupivacaine for effective pain relief after laparoscopic cholecystectomy. Ann R Coll Surg Engl 1993;75(6):437–439. PMID: 8285548.
  7. Duffield JA, Thomas ML, Moore JW, et al. Intraperitoneal local anesthetic instillation and postoperative infusion improves functional recovery following colectomy: a randomized controlled trial. Dis Colon Rectum 2018;61(10):1205–1216. DOI: 10.1097/DCR.0000000000001177.
  8. Shivhare P, Dugg P, Singh H, et al. A prospective randomized trial to study the effect of intraperitoneal instillation of ropivacaine in postoperative pain reduction in laparoscopic cholecystectomy. J Minim Invasive Surg Sci 2014;3(4):e189. PMID: 29962601.
  9. Wu CT, Borel C, Lee MS, et al. The Interaction effect of Perioperative cotreatment with dextromethorphan and intravenous lidocaine on pain relief and recovery of bowel function after laparoscopic cholecystectomy. Anesth Analg 2005;100(2):448–453. DOI: 10.1213/01.ANE.0000142551.92340.CC.
  10. Elhakim M, Amine H. Effects of intraperitoneal lidocaine combined with intravenous or intraperitoneal tenoxicam on pain relief and bowel recovery after laparoscopic cholecystectomy. Acta Anaesthesiol Scand 2000;44(8):929–933. DOI: 10.1034/j.1399-6576.2000.440806.x.
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