Comparison of efficacy of Intraperitonial nebulisation versus Intraperitonial instillation of Ropivacaine for post operative pain management in patients undergoing laparoscopic cholecystectomy under general anaesthesia .

Laparoscopic cholecystectomy is the preferred approach for gallbladder removal as it is

minimally invasive procedure and associated with many advantages over open surgery [1].

.Although laparoscopic surgeries are associated with reduced postoperative pain, reduced hospital

stay and faster recovery compared to open procedures, still patients often experience significant

discomfort and pain especially in the early postoperative period. Effective management of

postoperative pain is crucial not only for patient-comfort but also for reducing the risk of

complications, enhancing recovery, and facilitating early discharge. [2].

Pain experienced after laparoscopic cholecystectomy is mainly felt due to intraperitonial

insufflation of carbon dioxide resulting in the peritoneal stretching and Somatic pain from trocar

sites. shoulder pain resulting from diaphragmatic irritation due to retention of CO2

pneumoperitoneum is commonly observed postoperative period [4]

Administration of intraperitoneal local anasthetic in laparoscopic surgeries as part of a multimodal

approach to post op-Operative pain management is safe, but intraperitoneal instillation provides

limited pain relief [4]. Failure to achieve adequate pain-relief after intraperitoneal local anaesthetic

instillation may be attributed to the non-uniform distribution of local Anaesthetic throughout the

peritoneal surface [5]

Intraperitoneal mist instillation, a novel technique for drug administration, aims to achieve

uniform dispersion of local anaesthetic particles measuring 0.3 microns throughout the

peritoneal cavity. This procedure involves utilising the Aerogen Pro® device, which is

connected between the insufflator and the insufflation tubing. Tubing is then attached to the

umbilical port. The initiation of mist instillation coincides with the commencement of

laparoscopic gas insufflation, ensuring simultaneous and efficient dispersion of the

local anaesthetic particles.

Intraperitoneal mist instillation of Ropivacaine offers benefits such as reduced opioid

consumption, improved pain control, and faster recovery compared to traditional pain

management methods alone.

This randomised controlled trial aims to compare the efficacy of intraperitonial ropivacaine instillation

and intraperitonial ropivacaine nebulisation with aerogen pro device in laparoscopic

cholecystectomy.

Thus, we have designed a double blinded study and hypothesised that Intraperitoneal mist

instillation of Ropivacaine may offer better postoperative analgesia as compared to Intraperitonial

instillation