Preincisional and intraperitoneal ropivacaine plus normal saline infusion for postoperative pain relief after laparoscopic cholecystectomy: a randomized double-blind controlled trial.
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.


CONCLUSIONS
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.
Pappas-Gogos
George
G
Department of Surgery, G. Hatzikosta General Hospital, Makriyanni Avenue, Ioannina, Greece. pappasg8@otenet.gr
Tsimogiannis
Konstandinos E
KE
Zikos
Nicolaos
N
Nikas
Konstantinos
K
Manataki
Adamantia
A
Tsimoyiannis
Evangelos C
EC
D015746:Abdominal Pain / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control; D000328:Adult; D000368:Aged; D000577:Amides / Q000008:administration & dosage / Q000627:therapeutic use*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007263:Infusions, Parenteral; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000209:etiology; D010149:Postoperative Pain / Q000188:drug therapy* / Q000517:prevention & control; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects*; D011292:Premedication; D011446:Prospective Studies; D000077212:Ropivacaine; D020069:Shoulder Pain / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control; D012965:Sodium Chloride / Q000008:administration & dosage / Q000627:therapeutic use; D014839:Vomiting / Q000209:etiology
D000577:Amides; D000779:Anesthetics, Local; D012965:Sodium Chloride; D000077212:Ropivacaine