Pain reduction by continuous intraperitoneal nebulization of ropivacaine during gynecological laparoscopic surgery

Abstract

The objective of this study was to examine the analgesic effect of intraperitoneal nebulization of ropivacaine during gynecological laparoscopic procedures for patients anesthetized with an ultrashort-acting opiate. The study was a double-blinded placebo-controlled randomized trial (Canadian Task Force classification I) and involved 40 patients (20 patients in each arm) undergoing elective gynecological same-day outpatient laparoscopic surgery including unilateral/bilateral salpingo-oophorectomy or unilateral/ bilateral ovarian cystectomy at the University Hospital Ambulatory Gynecological Endoscopic Unit. The study group received 10 ml of 1 % ropivacaine, and the control group received 10 ml of sterile water by intraperitoneal nebulization. Vital signs were recorded and summarized. Postoperatively, patients were followed up for 24 h including visual analogue scale (VAS) scores and analgesic usage. Results showed no significant differences between the two groups in terms of patient characteristics and surgical data. There were no significant differences between the groups in postoperative VAS scores at rest at the different time intervals. VAS scores during strain showed significantly decreased pain at the postoperative 2-h interval (p<0.05). Postoperative opiate and nonopiate analgesia consumption was similar for both groups. Patients in the study groups required more antiemetic agents compared to the control group patients (p<0.05). There were no reported side effects related to ropivacaine. Intraperitoneal nebulization of 100 mg of ropivacaine during gynecological laparoscopy under general anesthesia with an ultrashort-acting opiate does not reduce postoperative pain and it does not reduce postoperative opiate and nonopiate analgesia consumption.

Intraperitoneal ropivacaine for post-operative pain following laparoscopic tubal ligation: a randomised double-blind placebo-controlled trial

“…Despite there being six times more randomised controlled trials in laparoscopic cholecystectomy, the evidence for intraperitoneal local analgesia during gynaecological and gastric laparoscopy appears to be stronger [18]. Unfortunately, the available data from trials focusing on pain relief after LTL were not only scarce but also conflicting in nature [19,22,24,25,37,38]. For example, intraperitoneal analgesia, whether alone or in combination with other local analgesia, was found to be an effective and safe method to manage post-operative pain after LTL in some reports [19,22,25,37], while others have found no benefit from this route [24,38].…”

“…Unfortunately, the available data from trials focusing on pain relief after LTL were not only scarce but also conflicting in nature [19,22,24,25,37,38]. For example, intraperitoneal analgesia, whether alone or in combination with other local analgesia, was found to be an effective and safe method to manage post-operative pain after LTL in some reports [19,22,25,37], while others have found no benefit from this route [24,38]. A reason for the failure of intraperitoneal local analgesia to reduce post-operative pain could be that these local analgesics may work better for local incisional pain rather than for visceral pain [39].…”

“…In fact, one of the elevan strategies described by Sou et al [7] to reduce pain after gynaecological laparoscopic surgery included intraperitoneal analgesia. Examples of some intraperitoneally used local analgesics are lignocaine [19,20], bupivacaine [21] meperidine [22], and recently, ropivacaine [23][24][25][26][27]. The latter has demonstrated a superior cardioprotective effect compared to bupivacaine [28][29][30], while providing longer pain relief and reducing opioid usage [31][32][33].…”

Eficacia de la ropivacaína 0,1 % intraperitoneal en el control del dolor postoperatorio en cirugía ginecológica laparoscópica

“…Nuestro estudio presenta varias limitaciones: un tamaño muestral reducido, baja concentración del anestésico local administrado, instilación del anestésico en 2 áreas frente a nebulización del mismo, que podría aportar una distribución mas homogénea del AL (32,33).Otras limitaciones podrían ser la administración de suero fisiológico a los controles, que según algunos estudios podría tener influencia sobre el dolor postlaparoscopia (30). Además, el tiempo de latencia desde la instilación del anestésico hasta el inicio de la cirugía (5 minutos) podría ser insuficiente.…”