The LAPLAP study: a randomized placebo‐controlled clinical trial assessing postoperative functional recovery using intraperitoneal local anaesthetic in laparoscopic colorectal surgery

Abstract

Aim Postoperative pain remains a major factor in recovery from colorectal resection. There is increasing interest in opioid‐sparing analgesia, and intraperitoneal local anaesthetic (IPLA) has recently been shown to be useful in minor laparoscopic and open colorectal procedures. The aim of this study was to evaluate the impact of IPLA on functional recovery following major laparoscopic surgery. In this controlled trial, mobility, as measured by the De Morton Mobility Index (DEMMI), was used as a surrogate for postoperative functional recovery. Method Patients undergoing laparoscopic colorectal resection were randomized either to continuous ropivacaine (0.2% at 4–6 ml/h) or to saline (0.9%) which were administered via intraperitoneal catheter for 3 days postoperatively. Results were analysed in a double‐blind manner. DEMMIs were assessed on postoperative days 1, 2, 3, 7 and 30, and data on pain, opioid consumption, gut and respiratory function, length of stay (LOS) and complications were recorded. Results Ninety‐six patients were recruited. There was no difference in primary outcome (i.e., functional recovery) between IPLA and placebo groups. Opioid consumption and LOS were similar between groups, and no differences were found for any secondary outcome measure. There were no adverse events related to ropivacaine. Conclusion Infusional intraperitoneal local anaesthetic appears to be safe but does not improve functional recovery or analgesic consumption following elective laparoscopic colorectal surgery, in the setting of an established enhanced recovery programme.

Role of regional anesthesia and analgesia in enhanced recovery after colorectal surgery: a systematic review of randomized controlled trials

“…The results of the search strategy are presented in figure 1. Thirteen studies meeting inclusion criteria for colorectal surgery and successful ERAS were included,37–49 comprising a total of 1170 patients, with variable methodological quality (figure 2). Only two studies (15.4%) were scored as low risk of bias in all domains 37 38.…”

“…Thirteen studies meeting inclusion criteria for colorectal surgery and successful ERAS were included,37–49 comprising a total of 1170 patients, with variable methodological quality (figure 2). Only two studies (15.4%) were scored as low risk of bias in all domains 37 38. The characteristics of included studies are summarized in online supplemental table 2.…”

“…One study investigated the addition of postoperative intraperitoneal ropivacaine 0.2% infusion for 3–5 days to standard ERAS protocols in 96 patients undergoing laparoscopic colorectal resection, with no difference found in any outcomes, including respiratory parameters or LOS (5 days in control group, 4 days in LA group, p=0.09) 37…”

Intravenous Local Anesthetic Compared With Intraperitoneal Local Anesthetic in Laparoscopic Colectomy

“…6,23 IPLA may have a lower rate of adverse effects including local anesthetic systemic toxicity due to reduced systemic absorption and a high first pass metabolism. 24 This is what allows for the utilization of less cardiotoxic and longer acting local anesthetics. 6 After a bolus of IPLA the levels increase in the blood stream with a mean Cmax of 1.01 to 4.32 mg/mL and a Tmax of 15 to 40 minutes.…”

The importance of laparoscopic surgery for early postoperative course in patients with colorectal carcinoma

“…With the advent of laparoscopic procedures in the treatment of colorectal cancer, numerous papers on this topic have been published. They showed an improvement in the quality of operative technique, and especially an advantage in the early postoperative recovery after this type of operative treatment [3,4,5]. The very beginning laparoscopically assisted colorectal surgery was promising, studies were done that confirmed that this type of surgery was less traumatic than open surgery.…”