Nebulized analgesia during laparoscopic appendectomy (NALA): A randomized triple-blind placebo controlled trial

Baird, Robert; Ingelmo, Pablo; Wei, Andrew H.; Meghani, Yash; Pérez, Eduardo; Pelletier, Helene; Auer, Grant; Mujallid, Razaz; Emil, Sherif; Laberge, Jean-Martin; Puligandla, Pramod S.; Shaw, Kenneth; Poenaru, Dan

doi:10.1016/j.jpedsurg.2018.10.029

Cited by 4 publications

(11 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This must have resulted in increased postoperative morphine consumption, masking potential analgesic effects of ropivacaine at later postoperative time intervals. In a study by Baird et al [ 21 ] nebulized ropivacaine did not reduce postoperative morphine consumption or pain scores after laparoscopic appendectomy. This study was performed on pediatric patients who underwent emergency appendicectomy for an underlying inflammatory process.…”

Section: Discussionmentioning

confidence: 99%

Intraperitoneal nebulization of ropivacaine for control of pain after laparoscopic cholecystectomy -A randomized control trial

Sandhya

Puthenveettil

Vinodan

2021

J Anaesthesiol Clin Pharmacol

View full text Add to dashboard Cite

Background and Aims: Use of high dose opioids following laparoscopic surgery delays discharge from the hospital. Unlike intraperitoneal instillation, nebulization has been reported to provide a homogeneous spread of local anesthetics and provide better analgesia. In our study, we aimed to assess the efficacy of intraperitoneal nebulization of local anesthetic in alleviating postoperative pain in patients undergoing laparoscopic cholecystectomy. Material and Methods: This randomized control double-blinded study was conducted after obtaining approval from the hospital ethics committee and informed consent from patients undergoing laparoscopic cholecystectomy under general anesthesia. Patients recruited were divided into two equal groups of 20 each. Group B received intraperitoneal nebulization with 4 ml of 0.75% ropivacaine and Group C received intraperitoneal nebulization with 4ml of saline before surgical dissection. Postoperative pain score using a numeric rating scale was monitored until 24 h, the need for rescue analgesics and associated complications were noted. Chi-square test, Student's test, and Mann–Whitney U test were used for statistical analysis. Results: The pain score was significantly less in Group B during rest and deep breathing up to 24 h with a P value <0.05. The pain score on movement was also less in Group B and this difference was statistically significant at 6 and 24 h ( P = 0.004 and 0.005, respectively). Tramadol consumption was less in Group B and was statistically significant at 24 h with P value of 0.044. No adverse events were noted. Conclusion: Intraperitoneal nebulization of ropivacaine is effective and safe in providing postoperative analgesia in patients undergoing laparoscopic cholecystectomy.

show abstract

Section: Discussionmentioning

confidence: 99%

Intraperitoneal nebulization of ropivacaine for control of pain after laparoscopic cholecystectomy -A randomized control trial

Sandhya

Puthenveettil

Vinodan

2021

J Anaesthesiol Clin Pharmacol

View full text Add to dashboard Cite

show abstract

“…Intraperitoneal nebulization of ropivacaine is claimed to be effective in most studies, but the study by Kaufman et al [18] on laparoscopic gynecologic surgeries showed no significant benefit of this technique, possibly because of their small sample size. Another study on laparoscopic appendectomy conducted in a pediatric population by Baird et al [19] showed no difference in morphine consumption and postoperative pain score, possibly because pain perception in the pediatric population was completely different from that in an adult population.…”

Section: Discussionmentioning

confidence: 99%

Intraperitoneal nebulization versus intraperitoneal instillation of ropivacaine for postoperative pain management following laparoscopic donor nephrectomy

Kumar

Nath

Agarwal

2019

Korean J Anesthesiol

View full text Add to dashboard Cite

Background: Laparoscopic donor nephrectomy is considered less painful than open nephrectomy but is still associated with significant postoperative pain. Studies reported that intraperitoneal instillation of local anesthetics provides uncertain pain relief after laparoscopic surgery. This randomized, double-blind study evaluated the effect of intraperitoneal nebulization of ropivacaine on postoperative pain relief after laparoscopic donor nephrectomy. Methods: Sixty patients undergoing elective laparoscopic donor nephrectomy were randomly assigned to receive either an instillation of 20 ml 0.5% ropivacaine after the induction of pneumoperitoneum or nebulization of 5 ml 1% ropivacaine before and after surgery. The primary outcome was the degree of pain relief (static and dynamic) after surgery. The secondary outcomes were postoperative fentanyl consumption, incidence of shoulder pain, unassisted walking and postoperative nausea and vomiting (PONV). Data were collected in the postanesthesia care unit (PACU) and at 6, 24, and 48 h after surgery. Results: Compared to patients in the instillation group, those in the nebulization group showed significant reductions in postoperative pain and fentanyl consumption, and none complained of significant shoulder pain (visual analog scale score ≥ 30 mm). Within 20 h of surgery, 13.3% of patients in the instillation group and 93.3% in the nebulization group started unassisted walking (absolute risk reduction, 38%; P = 0.001). In the nebulization group, PONV was significantly reduced in the PACU and at 6 h. Conclusions: Intraperitoneal nebulization of ropivacaine reduced postoperative pain, fentanyl consumption, referred shoulder pain, and PONV while enabling earlier mobility without any difference in the length of hospital stay.

show abstract

“…Two studies with adequate baseline analgesia investigated different methods regarding insufflation during laparoscopic appendicectomies in children 105,106 …”

Section: Regional Analgesia Techniquesmentioning

confidence: 99%

“…Yu et al 105 compared warm humidified carbon dioxide insufflation to standard insufflation, and Baird et al 106 compared nebulization of 0.5% ropivacaine at the onset of surgery to 0.9% saline nebulisation. Both studies reported no difference in pain intensity or opioid consumption.…”

Section: Regional Analgesia Techniquesmentioning

confidence: 99%

“…Two studies with adequate baseline analgesia investigated different methods regarding insufflation during laparoscopic appendicectomies in children. 105,106 Yu et al 105 compared warm humidified carbon dioxide insufflation to standard insufflation, and Baird et al 106 compared nebulization of 0.5% ropivacaine at the onset of surgery to 0.9% saline nebulisation. Both studies reported no difference in pain intensity or opioid consumption.…”

Section: Other Therapiesmentioning

confidence: 99%

See 1 more Smart Citation

Perioperative pain management for appendicectomy

Freys,

Bigalke,

Mertes

et al. 2024

European Journal of Anaesthesiology

View full text Add to dashboard Cite

BACKGROUND Despite being a commonly performed surgical procedure, pain management for appendicectomy is often neglected because of insufficient evidence on the most effective treatment options. OBJECTIVE To provide evidence-based recommendations by assessing the available literature for optimal pain management after appendicectomy. DESIGN AND DATA SOURCES This systematic review-based guideline was conducted according to the PROSPECT methodology. Relevant randomised controlled trials, systematic reviews and meta-analyses in the English language from January 1999 to October 2022 were retrieved from MEDLINE, Embase and Cochrane Databases using PRISMA search protocols. ELIGIBILITY CRITERIA We included studies on adults and children. If articles reported combined data from different surgeries, they had to include specific information about appendicectomies. Studies needed to measure pain intensity using a visual analogue scale (VAS) or a numerical rating scale (NRS). Studies that did not report the precise appendicectomy technique were excluded. RESULTS Out of 1388 studies, 94 met the inclusion criteria. Based on evidence and consensus, the PROSPECT members agreed that basic analgesics [paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs)] should be administered perioperatively for open and laparoscopic appendicectomies. A laparoscopic approach is preferred because of lower pain scores. Additional recommendations for laparoscopic appendicectomies include a three-port laparoscopic approach and the instillation of intraperitoneal local anaesthetic. For open appendicectomy, a preoperative unilateral transverse abdominis plane (TAP) block is recommended. If not possible, preincisional infiltration with local anaesthetics is an alternative. Opioids should only be used as rescue analgesia. Limited evidence exists for TAP block in laparoscopic appendicectomy, analgesic adjuvants for TAP block, continuous wound infiltration after open appendicectomy and preoperative ketamine and dexamethasone. Recommendations apply to children and adults. CONCLUSION This review identified an optimal analgesic regimen for open and laparoscopic appendicectomy. Further randomised controlled trials should evaluate the use of regional analgesia and wound infiltrations with adequate baseline analgesia, especially during the recommended conventional three-port approach. REGISTRATION The protocol for this study was registered with the PROSPERO database (Registration No. CRD42023387994).

show abstract

Nebulized analgesia during laparoscopic appendectomy (NALA): A randomized triple-blind placebo controlled trial

Cited by 4 publications

References 28 publications

Intraperitoneal nebulization of ropivacaine for control of pain after laparoscopic cholecystectomy -A randomized control trial

Intraperitoneal nebulization of ropivacaine for control of pain after laparoscopic cholecystectomy -A randomized control trial

Intraperitoneal nebulization versus intraperitoneal instillation of ropivacaine for postoperative pain management following laparoscopic donor nephrectomy

Perioperative pain management for appendicectomy

Contact Info

Product

Resources

About