Continuous preperitoneal infusion of ropivacaine provides effective analgesia and accelerates recovery after colorectal surgery: a randomized, double-blind, placebo-controlled study.
BACKGROUND
Blockade of parietal nociceptive afferents by the use of continuous wound infiltration with local anesthetics may be beneficial in a multimodal approach to postoperative pain management after major surgery. The role of continuous preperitoneal infusion of ropivacaine for pain relief and postoperative recovery after open colorectal resections was evaluated in a randomized, double-blinded, placebo-controlled trial.


METHODS
After obtaining written informed consents, a multiholed wound catheter was placed by the surgeon in the preperitoneal space at the end of surgery in patients scheduled to undergo elective open colorectal resection by midline incision. They were thereafter randomly assigned to receive through the catheter either 0.2% ropivacaine (10-ml bolus followed by an infusion of 10 ml/h during 48 h) or the same protocol with 0.9% NaCl. In addition, all patients received patient-controlled intravenous morphine analgesia.


RESULTS
Twenty-one patients were evaluated in each group. Compared with preperitoneal saline, ropivacaine infusion reduced morphine consumption during the first 72 h and improved pain relief at rest during 12 h and while coughing during 48 h. Sleep quality was also better during the first two postoperative nights. Time to recovery of bowel function (74 +/- 19 vs. 105 +/- 54 h; P = 0.02) and duration of hospital stay (115 +/- 25 vs. 147 +/- 53 h; P = 0.02) were significantly reduced in the ropivacaine group. Ropivacaine plasma concentrations remained below the level of toxicity. No side effects were observed.


CONCLUSIONS
Continuous preperitoneal administration of 0.2% ropivacaine at 10 ml/h during 48 h after open colorectal resection reduced morphine consumption, improved pain relief, and accelerated postoperative recovery.
Beaussier
Marc
M
Department of Anesthesiology and Intensive Care, St. Antoine Hospital, Paris, France. marc.beaussier@sat.aphp.fr
El'Ayoubi
Hanna
H
Schiffer
Eduardo
E
Rollin
Maxime
M
Parc
Yann
Y
Mazoit
Jean-Xavier
JX
Azizi
Louisa
L
Gervaz
Pascal
P
Rohr
Serge
S
Biermann
Celine
C
Lienhart
André
A
Eledjam
Jean-Jacques
JJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000577:Amides / Q000008:administration & dosage / Q000097:blood / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000772:Anesthesia, Local / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000097:blood / Q000627:therapeutic use*; D003107:Colorectal Surgery / Q000009:adverse effects; D004311:Double-Blind Method; D004333:Drug Administration Routes; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage; D010149:Postoperative Pain / Q000188:drug therapy* / Q000209:etiology; D010537:Peritoneum / Q000187:drug effects; D011446:Prospective Studies; D020127:Recovery of Function / Q000187:drug effects; D000077212:Ropivacaine; D012965:Sodium Chloride / Q000008:administration & dosage; D016896:Treatment Outcome
D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D012965:Sodium Chloride; D009020:Morphine; D000077212:Ropivacaine