title: Disposition and clinical outcome after intraperitoneal meperidine and ropivacaine administration during laparoscopic surgery.
abstract: BACKGROUND
  Limited evidence supports the efficacy of intraperitoneal (IP) meperidine or local anesthetic for postoperative analgesia. Our study aims were to investigate analgesic efficacy and to quantify the plasma concentrations of meperidine and ropivacaine after IP administration. The null hypothesis was that there was no significant difference among groups for dynamic pain in the first 24 h after major abdominal laparoscopic surgery.
  
  
  METHODS
  This double-blind, five parallel group, placebo-controlled, two-center trial randomized 250 women having laparoscopic surgery to receive IP meperidine 50 or 100 mg (groups M50 and M100), ropivacaine 150 mg (group R150), meperidine 50 mg and ropivacaine 150 mg (group M50R150), all with intramuscular saline, or IP saline, with intramuscular meperidine 50 mg (group C). The primary outcome was pain during recovery. A pharmacokinetic profile of the drugs was obtained.
  
  
  RESULTS
  There were no significant differences among groups for mean (sd) dynamic pain scores in the postoperative care unit (2.2 [2.8], 2.5 [3.3], 1.6 [2.5], 2.6 [3.2], 2.7 [3.2] for groups C, M50, M100, R150, and M50R150, P = 0.50) or thereafter. There were no significant differences among groups for pain scores at rest, IV morphine use, recovery characteristics and patient satisfaction. After IP administration of meperidine 50 mg the plasma concentration (median average 55-60 microg/L) was approximately half that of an equivalent intramuscular dose (median average 113 mug/L).
  
  
  CONCLUSIONS
  Compared with systemic opioid, IP meperidine and ropivacaine, alone or in combination, did not produce better pain relief or opioid dose-sparing after laparoscopic surgery.
authors.affiliation: Pharmacology and Anaesthesiology Unit, School of Medicine and Pharmacology, The University of Western Australia, Perth, Western Australia, Australia. michael.paech@health.wa.gov.au
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Paech
authors.forename: Kenneth F
authors.initials: KF
authors.lastname: Ilett
authors.forename: L Peter
authors.initials: LP
authors.lastname: Hackett
authors.forename: Madhu
authors.initials: M
authors.lastname: Page-Sharp
authors.forename: Richard W
authors.initials: RW
authors.lastname: Parsons
mesh_terms: D000328:Adult; D000339:Affect / Q000187:drug effects*; D000577:Amides / Q000008:administration & dosage* / Q000097:blood / Q000493:pharmacokinetics; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000097:blood / Q000493:pharmacokinetics; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000097:blood / Q000493:pharmacokinetics; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D007274:Injections, Intraperitoneal; D007275:Injections, Intravenous; D010535:Laparoscopy; D008297:Male; D008614:Meperidine / Q000008:administration & dosage* / Q000097:blood / Q000493:pharmacokinetics; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D017060:Patient Satisfaction; D000077212:Ropivacaine; D013997:Time Factors; D016896:Treatment Outcome; D014904:Western Australia
chemical_list: D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D009020:Morphine; D000077212:Ropivacaine; D008614:Meperidine