Quality of recovery following intraperitoneal bupivacaine with and without dexamethasone in laparoscopic cholecystectomy: a randomized controlled trial

Intraperitoneal local anesthetic (IPLA) instillation is a simple, safe, and cost‑effective analgesic technique recommended by PROSPECT guidelines for laparoscopic cholecystectomy. Dexamethasone may enhance IPLA’s analgesic and antiemetic effects, but their combined impact on overall postoperative quality of recovery remains unclear. This study evaluated the effect of intraperitoneal bupivacaine with and without dexamethasone on the 24‑h postoperative quality of recovery (QoR‑15) score following laparoscopic cholecystectomy.

Hundred-and-ten adults undergoing elective laparoscopic cholecystectomy were randomly allocated to receive either intraperitoneal 0.25% bupivacaine 30 ml (Group B) or bupivacaine 30 ml with 8 mg dexamethasone (Group BD). The primary objective was to evaluate the 24‑h postoperative QoR‑15 score using the Hindi QoR‑15 questionnaire. The secondary objectives were: to determine the study‑specific Minimum clinically important difference for QoR-15; analyze individual QoR-15 domain scores; and compare time to first rescue analgesia, total analgesic consumption, and PONV incidence between groups.

Adjusted 24‑h QoR‑15 scores were comparable between Group B [122.3, 95%CI 120.0, 124.6] and Group BD [122.1, 95%CI 119.8, 124.3] (p = 0.894). Group BD demonstrated significantly prolonged time to first rescue analgesia (12.3 h vs 7.6 h; p < 0.0001) and lower nausea incidence (p = 0.01). Physical independence showed the lowest recovery domain in both groups, 63.9%). The study‑specific MCID for QoR‑15 deterioration was16points (AUC0.636; p = 0.016).

Intraperitoneal bupivacaine with dexamethasone did not demonstrate superiority over intraperitoneal bupivacaine alone in improving global QoR-15 recovery at 24 h after laparoscopic cholecystectomy, despite providing significantly better analgesia and emesis control. Physical independence was the main limiting domain, emphasizing the need for early mobilization strategies to optimize holistic postoperative recovery.