Intraperitoneal Local Anesthetic Improves Recovery After Colon Resection

Abstract

Instillation and infusion of intraperitoneal ropivacaine after colectomy improves early surgical recovery. This was associated with a blunting of postsurgical systemic cytokines and cortisol. Patients also had significantly reduced pain and opioid use over and above the effect of an epidural infusion. Therefore a transient chemical afferentectomy with clinical benefit is possible with this method. A longer IPLA infusion duration needs to be studied. This study is registered at clinicaltrials.gov and carries the ID number NCT00722709.

Time to Readiness for Discharge is a Valid and Reliable Measure of Short‐Term Recovery After Colorectal Surgery

“…Time to achieve discharge criteria in ERAS studies varied from 3 to 5 days [10][11][12] compared to 6 days in our study. Time to pass flatus and time to tolerate solid food was also longer in the current study than in the studies using ERAS (3 vs. 2 days and 5 vs. 1-3 days, respectively) [10][11][12]23] Although participants in our study were encouraged to mobilize from POD 1, they took an average of 5 days to achieve discharge criteria regarding mobilization and self-care (i.e., ability to sit up, walk, go to the toilet, dress, shower, and climb stairs if needed at home). In ERAS studies, the time to achieve similar criteria (e.g., mobilization as occurred preoperatively) was approximately 3 days [23,31,34,35].…”

“…During the last decade, numerous studies in colorectal surgery have evaluated TRD as an index of short-term recovery [5][6][7][8][9][10][11][12]. Although this provides evidence of face validity (i.e., researchers believe that TRD measures recovery), our study is the first to assess formally the psychometric properties of this measure.…”

Aerosolized Intraperitoneal Local Anesthetic for Laparoscopic Surgery: A Randomized, Double‐Blinded, Placebo‐Controlled Trial

“…Studies evaluating different techniques of local anesthetic delivery including peri-portal infiltration [5,6], diaphragmatic irrigation [7], instillation into the sub-diaphragmatic area [8], or diffuse instillation [2,9] have shown conflicting results to date.…”

The effect of perioperative psychological intervention on fatigue after laparoscopic cholecystectomy: a randomized controlled trial

“…In addition, we have shown that intraperitoneal cytokine levels are directly correlated with the PSF experience in patients undergoing abdominal surgery [26]. These changes are believed to cause a direct effect on the central nervous system (CNS) by the vagus nerve and have been targets of biological intervention, including glucocorticoids and intraperitoneal signal dampening, with positive effects [27,28].…”