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Preincisional and intraperitoneal ropivacaine plus normal saline infusion for postoperative pain relief after
George Pappas-Gogos1, Konstandinos E Tsimogiannis, Nicolaos Zikos
1Department of Surgery, G. Hatzikosta General Hospital, Makriyanni Avenue, Ioannina, Greece. pappasg8@otenet.gr
Background:
A clinical trial was designed to assess the use of preincisional and intraperitoneal ropivacaine, combined or not with normal saline, to reduce pain after laparoscopic cholecystectomy (LC).
Methods:
For this trial, 120 patients were randomly assigned to six groups. For all the patients, preincisional local infiltration of ropivacaine around the trocar wounds was performed. Group A had infusion of ropivacaine at the beginning of the LC. Group B had infusion of ropivacaine at the beginning of the LC plus normal saline infusion at the end. Group C had normal saline infusion and ropivacaine at the end of the LC. Group D had infusion of ropivacaine at the beginning of the LC plus normal saline infusion at the end and a subhepatic closed drain. Group E had ropivacaine at the end of the LC. Group F (control group) had neither ropivacaine nor normal saline infusion. Shoulder tip and abdominal pain were registered at 2, 4, 6, 12, 24, 48, and 72 h postoperatively using a visual analog score (VAS).
Results:
Significantly lower pain scores were observed in group B than in group A at 2, 4, 6, 12, and 24 h or in groups C, D, E, and F at 2, 4, 6, 12, 24, and 48 h. Group A also had significantly lower pain scores than groups C, D, E, and F at 2, 4, 6, 12, 24, and 48 h. Requests for analgesics also were significantly less in group B than in group A at 2, 4, 6, 12, and 24 h or in groups C, D, and E at 2, 4, 6, 12, 24, and 48 h. Demand for additional analgesia was less in group B than in groups A, C, D, E, and F at 2, 4, 6, 12, and 24 h and in group A than in groups C, D, E, and F at 2, 4, 6, and 12 h.
Conclusion:
Preincisional local infiltration plus intraperitoneal infusion of ropivacaine at the beginning of LC combined with normal saline infusion at the end of the procedure is a safe and valid method for reducing pain after LC.
