title: Multi-regional local anesthetic infiltration during laparoscopic cholecystectomy in patients receiving prophylactic multi-modal analgesia: a randomized, double-blinded, placebo-controlled study.
abstract: Pain is the dominant complaint after laparoscopic cholecystectomy. No study has examined the combined effects of a somato-visceral blockade during laparoscopic cholecystectomy. Therefore, we investigated the effects of a somato-visceral local anesthetic blockade on pain and nausea in patients undergoing elective laparoscopic cholecystectomy. In addition, all patients received multi-modal prophylactic analgesic treatment. Fifty-eight patients were randomized to receive a total of 286 mg (66 mL) ropivacaine or 66 mL saline via periportal and intraperitoneal infiltration. During the first 3 postoperative h, the use of morphine and antiemetics was registered, and pain and nausea were rated hourly. Daily pain intensity, pain localization, and supplemental analgesic consumption were registered the first postoperative week. Ropivacaine reduced overall pain the first two hours and incisional pain for the first three postoperative hours (P < 0.01) but had no apparent effects on intraabdominal or shoulder pain. During the first 3 postoperative h, morphine requirements were lower (P < 0.05), and nausea was reduced in the ropivacaine group (P < 0.05). Throughout the first postoperative week, incisional pain dominated over other pain localizations in both groups (P < 0.01). We conclude that the somato-visceral local anesthetic blockade reduced overall pain during the first 2 postoperative h, and nausea, morphine requirements, and incisional pain were reduced during the first 3 postoperative h in patients receiving prophylactic multi-modal analgesic treatment.
  
  
  CONCLUSIONS
  A combination of incisional and intraabdominal local anesthetic treatment reduced incisional pain but had no effect on deep intraabdominal pain or shoulder pain in patients receiving multimodal prophylactic analgesia after laparoscopic cholecystectomy. Incisional pain dominated during the first postoperative week. Incisional infiltration of local anesthetics is recommended in patients undergoing laparoscopic cholecystectomy.
authors.affiliation: Department of Surgical Gastroenterology 435, University of Copenhagen, Hvidovre Hospital, Denmark. bisgaard@dadlnet.dk
authors.forename: T
authors.initials: T
authors.lastname: Bisgaard
authors.forename: B
authors.initials: B
authors.lastname: Klarskov
authors.forename: V B
authors.initials: VB
authors.lastname: Kristiansen
authors.forename: T
authors.initials: T
authors.lastname: Callesen
authors.forename: S
authors.initials: S
authors.lastname: Schulze
authors.forename: H
authors.initials: H
authors.lastname: Kehlet
authors.forename: J
authors.initials: J
authors.lastname: Rosenberg
mesh_terms: D015746:Abdominal Pain / Q000517:prevention & control; D000328:Adult; D000368:Aged; D000577:Amides / Q000008:administration & dosage*; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use*; D000772:Anesthesia, Local / Q000379:methods; D000779:Anesthetics, Local / Q000008:administration & dosage*; D000932:Antiemetics / Q000008:administration & dosage / Q000627:therapeutic use; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects; D004311:Double-Blind Method; D004338:Drug Combinations; D017558:Elective Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007274:Injections, Intraperitoneal; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D010919:Placebos; D011169:Portal Vein; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control; D000077212:Ropivacaine; D020069:Shoulder Pain / Q000517:prevention & control
chemical_list: D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000932:Antiemetics; D004338:Drug Combinations; D010919:Placebos; D009020:Morphine; D000077212:Ropivacaine