# Postoperative Pain Profiles Associated With Pre-incisional Intravenous Paracetamol or Port-Site Infiltration of 0.5% Ropivacaine in Laparoscopic Cholecystectomy: An Observational Study

## TL;DR

This study compares two pre-surgery pain management techniques in laparoscopic cholecystectomy and finds that one may lead to less need for additional pain relief.

## Contribution

The study provides observational evidence on the effectiveness of pre-incisional analgesic practices in laparoscopic cholecystectomy.

## Key findings

- Port-site ropivacaine was associated with a lower need for rescue analgesia compared to intravenous paracetamol.
- Postoperative pain levels decreased similarly in both groups over 24 hours.
- No clear predictors of rescue analgesia were identified.

## Abstract

Objective: This study aimed to describe and compare postoperative pain patterns associated with two commonly used pre-incisional analgesic practices: intravenous paracetamol and port-site infiltration of 0.5% ropivacaine in patients undergoing laparoscopic cholecystectomy.

Methodology: This observational study included 68 adult patients undergoing elective laparoscopic cholecystectomy under general anesthesia between December 2019 and April 2021. Ethical approval was obtained, and informed consent was secured from all participants. According to routine anesthetic practice, patients received either pre-incisional intravenous paracetamol (Group P, n = 34 (50%)) or port-site infiltration with 0.5% ropivacaine (Group R, n = 34 (50%)). Postoperative pain was assessed using the visual analog scale (VAS) at defined postoperative time points, and the need for rescue analgesia and the incidence of postoperative nausea and vomiting (PONV) were recorded.

Results: A total of 68 patients were analyzed, with comparable baseline characteristics between the intravenous paracetamol and port-site ropivacaine groups (mean age 42.5 ± 12.2 years; females 64.7%). Postoperative pain was observed in 48 (70.6%) patients, with a similar distribution between the two groups. Mean VAS scores declined from 7.55 ± 0.75 at 0 hour to 3.15 ± 1.4 at 24 hours in both groups. Rescue analgesia within 24 hours was required in 30 (44.1%) patients, more frequently in the intravenous paracetamol group (58.8%) than the port-site ropivacaine group (29.4%). Logistic regression showed higher, but non-significant, odds of rescue analgesia with intravenous paracetamol (OR 2.25; 95% CI 0.92-5.50).

Conclusion: Pre-incisional intravenous paracetamol combined with port-site infiltration of ropivacaine produces a predictable postoperative pain trajectory following laparoscopic cholecystectomy. Although the specific effect of port-site ropivacaine on local incision pain could not be isolated, the intervention contributes to overall pain control. No clear predictors of rescue analgesia were identified. These findings highlight the importance of incorporating site-specific analgesia into a broader multimodal pain management strategy to optimize postoperative comfort.