COMPARISON OF INTRA VENOUS KETOROLAC VERSUS INTRA PERITONEAL BUPIVACAINE IN POST LAPAROSCOPIC CHOLECYSTECTOMY PATIENTS IN TERMS OF POSTOPERATIVE PAIN SCORE AND MEAN TIME FIRST REQUEST FOR ANALGESIA

Abstract

Background: Postoperative pain has become a significant issue after the laparoscopic cholecystectomy, and it can lead to an increase in rescue analgesia. Commonly used analgesic methods include intraperitoneal bupivacaine and intravenous ketorolac that may have different effectiveness depending on clinical circumstances. Aim: To compare intravenous ketorolac with intraperitoneal bupivacaine in terms of postoperative pain intensity, hemodynamic parameters, and rescue analgesic requirements following laparoscopic cholecystectomy. Methods: A randomized controlled trial was conducted at the Department of General Surgery, Doctors Hospital & Medical Centre, Lahore. A total of 104 patients aged 25–60 years with ASA physical status I or II undergoing laparoscopic cholecystectomy for gallstone disease were randomly allocated into two equal groups. The Bupivacaine Group was 30 mL of 0.25% intraperitoneal bupivacaine and the Ketorolac Group received 30 mg of intravenous ketorolac. The visual analogue scale was used to measure postoperative pain, blood pressure, heart rate, respiratory rate and rescue analgesic needs were also noted during the postoperative period. Statistical analysis was performed using SPSS version 24, with p<0.05 considered statistically significant.  Results: The demographic and clinical parameters at the baseline were similar in both groups, and there were no significant differences in age, sex, weight, ASA grade, or duration of the surgery (p>0.05). The ketorolac group showed a considerable dropping in systolic and diastolic blood pressure levels at 8, 12 and 24 hours after surgery. The heart rate and respiratory rate were similar in both groups during the period of observation. The mean scores of VAS pain were lower at all levels with ketorolac, except at 18 hours, where statistically significant was demonstrated at 6 hours (p=0.05) and at 24 hours (p=0.006). The rescue analgesics needs were also much higher in the ketorolac group than in the bupivacaine group (24.0% vs. 44.1%; χ²=17.04, p<0.05). Conclusion: The intravenous ketorolac also gave an excellent postoperative analgesia over the intraperitoneal bupivacaine as seen in lower pain scores at critical time points during the postoperative phase and a reduced need to use rescue analgesia.