[Multimodal analgesia in elective laparoscopic cholecystectomy. A double-blind randomized controlled trial].
BACKGROUND
The aim of this study was to test the effects of preincisional parietal and intraperitoneal infiltration with ropivacaine (R) on postoperative pain after elective laparoscopic cholecystectomy.


METHODS
60 patients scheduled for laparoscopic cholecystectomy performed by the same surgeon were enrolled in a randomized, controlled double-blind trial. All patients received the same general anesthesia protocol and Ig i.v. paracetamol was infused after induction of anesthesia for postoperative analgesia, repeated postoperatively each 6 hours, up to 4 g/ 24 h. After induction of anesthesia, the patients were randomized in 4 groups (15 patients each): group A received preincisional parietal infiltration of 20 ml normal saline (NS) solution and 20 ml R0, 25% intraperitoneal instillation; group B, 20 ml R0, 0.25% preincisional parietal and 20 ml NS intraperitoneal; group C, 20 ml R0, 25% preincisional parietal and 20 ml R0, 25% intraperitoneal; group D (control), 20 ml NS preincisional local and 20 ml NS intraperitoneal. Tramadol was used as a rescue analgesic Primary end points: were postoperative pain at Oh, 2h, 6h, 12h, 24h on visual analogue scale (VAS 0-100 mm) score and rescue analgesic requirements.


RESULTS
We found no differences in demographics, length of surgery time and hospital stay (total 3.38 +/- 0.22 days). VAS was significantly lower at all intervals in groups C versus D and at Oh, 6h and 12 h in group C versus group A and B (p < 0.05). We found no influence on shoulder pain. Tramadol doses required were significantly lower in group C vs. D (0,73 +/- 1.10 vs 1,93 +/- 1.03, p = 0.017).


CONCLUSIONS
Ropivacaine shows significant favorable effects on postoperative pain after laparoscopic cholecystectomy when using both parietal and intraperitoneal instillation in combination with perioperative i.v. paracetamol.
Nicolau
A E
AE
Clinica de Chirurgie, Spitalul Clinic de Urgenţă Floreasca Bucureşti. anicolau@easynet.ro
Merlan
V
V
Grecu
Irina
I
Nicolau
Mirela
M
Micu
B
B
D000082:Acetaminophen / Q000008:administration & dosage; D000328:Adult; D000368:Aged; D000577:Amides / Q000008:administration & dosage; D000698:Analgesia / Q000379:methods*; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007274:Injections, Intraperitoneal; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology* / Q000517:prevention & control*; D011300:Preoperative Care; D011446:Prospective Studies; D000077212:Ropivacaine; D014147:Tramadol / Q000008:administration & dosage; D016896:Treatment Outcome
D000577:Amides; D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000082:Acetaminophen; D014147:Tramadol; D000077212:Ropivacaine