Intraperitoneal ropivacaine and early postoperative pain and postsurgical outcomes after laparoscopic herniorrhaphy in toddlers: a randomized clinical trial
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Updated: Mar 18, 2026
An Experimental Paradigm for the Prediction of Post-Operative Pain PPOP
Published on: January 27, 2010
Xuebi Tian1, Ping Yang1, Tiefen Su2
1Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
Insights
Intraperitoneal ropivacaine significantly reduced early postoperative pain and improved bowel function recovery in toddlers undergoing laparoscopic herniorrhaphy. This method offers a beneficial strategy for managing pain after pediatric laparoscopic surgery.
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Pain Management
Background:
- Inadequate postoperative pain management in children can lead to adverse physiological effects and prolonged hospital stays.
- Effective pain control is crucial for improving patient outcomes and recovery after pediatric surgical procedures.
Purpose of the Study:
- To evaluate the efficacy of intraperitoneal ropivacaine in alleviating postoperative pain in toddlers.
- To assess the impact of intraperitoneal ropivacaine on bowel function recovery and emetic events following laparoscopic herniorrhaphy.
Main Methods:
- A randomized controlled trial involving 76 children (9 months to 3 years) undergoing laparoscopic herniorrhaphy.
- Participants received either intraperitoneal ropivacaine or saline before surgery, with pain assessed using the FLACC scale.
- Key outcomes included postoperative analgesic consumption, time to flatus and first stool, and incidence of emetic events.
Main Results:
- Children receiving intraperitoneal ropivacaine experienced significantly less pain in the first 4 hours post-surgery compared to the control group.
- The ropivacaine group showed reduced analgesic requirements, shorter time to flatus and first stool, and a lower incidence of emetic events.
- Statistical significance (P < 0.05) was observed across all measured parameters, indicating a clear benefit of ropivacaine.
Conclusions:
- Intraperitoneal ropivacaine is effective in reducing early postoperative pain and enhancing recovery after laparoscopic herniorrhaphy in toddlers.
- Intraperitoneal local anesthesia (IPLA) with ropivacaine represents a valuable strategy for managing postoperative pain in pediatric laparoscopic surgery.
- The findings support the use of intraperitoneal ropivacaine for improved patient outcomes in this surgical population.
Background:
Postoperative pain can cause physiological distress, postoperative complications, and extended lengths of hospitalized stay. In children, management of postoperative pain is still recognized as being inadequate.
Objective:
The aim of this trial was to investigate the effects of intraperitoneal ropivacaine on postoperative pain, and recovery of bowel function and emetic events after laparoscopic herniorrhaphy in toddlers.
Methods:
Seventy-six children aged from 9 months to 3 years were recruited between August 2013 and June 2014 at Tongji Hospital and randomly assigned into two groups. One group received intraperitoneal ropivacaine right before surgery and the control group received intraperitoneal saline. A standard combined general anesthesia procedure was performed under regular monitoring. Postoperative pain was assessed by the FLACC scale. Postoperative analgesic consumption, time to flatus, time to first stool, and postoperative emetic events were also recorded.
Results:
When compared with the control group, children who received intraperitoneal ropivacaine experienced less pain 0-4 h after surgery [P < 0.001, difference in median FLACC (95% CI) for 2 h time point is 2.00 (0.87-3.13), for 4 h time point is 1.00 (0.55-1.45)]. In addition, the number of toddlers who received analgesia 0-24 h after surgery in the ropivacaine group was lower than that in the control group [P < 0.001, difference in proportions (95% CI) is 0.575 (0.3865-0.7638)]. Compared with the control group, time to flatus in ropivacaine group was also much shorter [21.1 h vs 16.7 h, P = 0.04, difference in mean (95% CI) is 4.4 (1.49-7.28)], and the time to first stool after surgery was earlier in the ropivacaine group [30.7 h vs 25.6 h, P = 0.003, difference in mean (95% CI) is 5.1 (1.78-8.45)]. Furthermore, the incidence of emetic events in the ropivacaine group was significantly lower than the control group [32.4% vs 11.1%, P = 0.03, difference in proportions (95% CI) is 0.212 (0.0246-0.4002)].
Conclusion:
The present results indicate that intraperitoneal ropivacaine reduces early postoperative pain and improves recovery after laparoscopic herniorrhaphy in toddlers. Therefore, IPLA is a good stratagem for postoperative pain management after laparoscopic surgery in toddlers.
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