Intraperitoneal subdiaphragmatic Ropivacaine instillation for prevention of shoulder tip pain after laparoscopic surgery in high-risk patients: A Randomized Controlled Trial

Study objective: To evaluate the efficacy of intraperitoneal subdiaphragmatic instillation of Ropivacaine on shoulder tip and upper abdominal pain after gynecological laparoscopic surgery Study Design: It is a prospective, randomized controlled trial (Canadian task Force Classification I ). 118 women at high risk for postoperative shoulder tip pain, undergoing gynecological laparoscopic surgeries between October 2017 and January 2020 at Paul’s Hospital, Centre for advanced endoscopy & infertility treatment, Kochi, India were included in the study. Women in the study group (Group A) received 40 ml of 0.2% Ropivacaine, sprayed under the diaphragm immediately after the creation of pneumoperitoneum. Women in the control group (Group B), did not receive Ropivacaine. Results: Postoperative shoulder tip pain was assessed using the Visual Analogue Scale at 1, 4, 12 and 20 hours after surgery. The pain scores and requirement of postoperative analgesia were compared between the two groups. 54 patients were in the study group, and 64 patients in the control group completed the study. Incidence of shoulder tip and upper abdominal pain was 11.1 % in group A and 26.5 % in group B. It was significantly higher among patients who did not receive Ropivacaine with a P-value of 0.034. The number needed to treat (NNT)to get pain relief is 6.66 (n = 7) The mean pain scores were the highest at the 12th hour after surgery in both groups. At that time, the mean shoulder tip and upper abdominal pain score were 5.5 ± 1 in group A and 6.07 ± 1.3 in group B. The requirement of postoperative analgesia was comparable between the two groups.