The role of intraperitoneal ropivacaine in laparoscopic appendicectomy: a prospective, double‐blinded randomized control Australian study

Abstract

Background: Currently, intraoperative use of local anaesthetic is not routinely given in all laparoscopic appendicectomies. Although its use has been widely studied in laparoscopic hernia repairs, gynaecological laparoscopy and laparoscopic cholecystectomies, there are no published trials of the use of intraperitoneal local anaesthetic during laparoscopic appendicectomy in the Australasian setting. The aim of this study was to determine whether the use of intraperitoneal ropivacaine during laparoscopic appendicectomy will reduce the amount of post-operative opiate analgesia used, abdominal pain, post-operative nausea or vomiting, shoulder tip pain and length of hospital stay. Methods: A randomized double-blinded placebo versus control trial was conducted with patients with clinically diagnosed appendicitis undergoing laparoscopic appendicectomy. Primary outcomes measured were the number of times the patient-controlled analgesia (PCA) button was pressed post-operatively and the average and total amount of fentanyl from PCA consumed during the post-operative period from 0 to 6 h and from 6 to 16 h. Results: A total of 86 patients with 43 patients in the placebo normal saline group and 43 patients in the treatment ropivacaine group were included in the study. During the immediate post-operative period (0-6 h), there was a statistically significant reduction in the number of times the PCA button was pressed in the ropivacaine group compared to the normal saline group (16 versus 24 times, P = 0.02). Conclusion: Intraperitoneal ropivacaine has an analgesic effect for patients up to 6 h following emergency laparoscopic appendicectomy.

Pain Management During Adult Laparoscopic Appendectomy: A Systematic Review

“…Furthermore, some physicians chose to premedicate their patients with individualized doses of midazolam based on their weight [10][11][12][13]. For anesthesia induction, patients were administered a combination of 1-3 mg/kg propofol, 1-2 μg/kg fentanyl, 0.1 mg/kg vecuronium, 1-1.5 mg/kg suxamethonium, and/or 1-1.5 mg/kg desflurane in oxygen-enriched air mixture, and this was maintained typically with sevoflurane 1-3% with oxygen [11][12][13][14][15][16][17][18]. Alternatively, another study gave their patients 5 mg/kg thiopental and 0.6 mg/kg rocuronium intravenously for anesthesia induction and tracked if they altered pain following surgery [16,17].…”

“…Infiltration of the wound was also a choice for preoperative pain management. It was done by using levobupivacaine or ropivacaine in the skin and pre-peritoneal space before introducing the ports and then again after the third port was introduced [13,15,19].…”

“…After administering IV 1.5 mg/kg lidocaine, some patients were continuously infused with IV lidocaine at 2 mg/kg/h [17]. Other physicians decided to use IV 1 g of paracetamol, parecoxib, dexamethasone, granisetron, and ketorolac [15,19]. For additional pain relief, IV fentanyl was given alone or along with ketamine [18,20].…”

“…For additional pain relief, IV fentanyl was given alone or along with ketamine [18,20]. At the end of the procedure, one study instilled blinded solutions using either a placebo of 0.9% saline or 0.2% ropivacaine, while another administered bupivacaine [15,22].…”

Preemptive analgesia in the “non-tube no fasting” fast track program for resectable esophageal carcinoma

“…The analgesic strategy of local infiltration can provide a strong analgesic effect and reduce the application of opioids after surgery, thereby reducing adverse events and shortening hospitalization (7)(8)(9). A prospective, doubleblinded, randomized, controlled trial in Australia reported by Huang et al (10) showed that the local intraperitoneal injection of ropivacaine had an analgesic effect within 6 h after emergency laparoscopic appendectomy and reduced the dosage of postoperative opioid analgesics. In a prospective randomized control trial, Liang et al (11) studied the efficacy and safety of different doses of ropivacaine for laparoscopy-assisted infiltration analgesia in patients undergoing laparoscopic cholecystectomy.…”