title: Peritrocal and intraperitoneal ropivacaine for laparoscopic cholecystectomy: a prospective, randomized, double-blind controlled trial.
abstract: BACKGROUND
  The goal of this study was to evaluate the effect of peritrocal, intraperitoneal, or combined peritrocal-intraperitoneal ropivacaine on the parietal, visceral, and shoulder tip pain after laparoscopic cholecystectomy.
  
  
  METHODS
  Eighty patients were randomly assigned to four groups. Group A received peritrocal and intraperitoneal saline. Group B received peritrocal saline and intraperitoneal ropivacaine. Group C received peritrocal ropivacaine and intraperitoneal saline. Group D received peritrocal and intraperitoneal ropivacaine. The parietal, visceral, and shoulder tip pain were assessed at 2, 4, 8, 12, 24, and 48 h postoperatively using a visual analog scale (VAS). The frequency of the patient pushing the button of the PCA and fentanyl use were also recorded.
  
  
  RESULTS
  In visceral pain, significantly lower VAS scores were observed in Group B from 2 to 4 h and in Group D from 2 to 8 h. In parietal pain, significantly lower VAS scores were observed in Group C from 4 to 24 h and in Group D from 2 to 12 h. In shoulder tip pain, significantly lower VAS scores were observed in Group B from 4 to 48 h and in Group D from 2 to 12 h. The fentanyl use and the frequency to push the button of the PCA were the highest in Group A and the lowest in Group D at every time point.
  
  
  CONCLUSIONS
  We conclude that peritrocal infiltration of ropivacaine significantly decreases parietal pain and intraperitoneal instillation of ropivacaine significantly decreases the visceral and shoulder tip pain. Their effects are additive with respect to the total pain.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine, Seoul, Korea.
authors.forename: Su Man
authors.initials: SM
authors.lastname: Cha
authors.forename: Hyun
authors.initials: H
authors.lastname: Kang
authors.forename: Chong Wha
authors.initials: CW
authors.lastname: Baek
authors.forename: Yong Hun
authors.initials: YH
authors.lastname: Jung
authors.forename: Gill Hoi
authors.initials: GH
authors.lastname: Koo
authors.forename: Beom Gyu
authors.initials: BG
authors.lastname: Kim
authors.forename: Yoo Shin
authors.initials: YS
authors.lastname: Choi
authors.forename: Seong Jae
authors.initials: SJ
authors.lastname: Cha
authors.forename: Young Joo
authors.initials: YJ
authors.lastname: Cha
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000577:Amides / Q000008:administration & dosage* / Q000627:therapeutic use*; D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000627:therapeutic use*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D004311:Double-Blind Method; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007263:Infusions, Parenteral; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology* / Q000517:prevention & control*; D011446:Prospective Studies; D000077212:Ropivacaine; D020069:Shoulder Pain / Q000209:etiology / Q000517:prevention & control; D016896:Treatment Outcome; D059265:Visceral Pain / Q000209:etiology / Q000517:prevention & control
chemical_list: D000577:Amides; D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D000077212:Ropivacaine; D005283:Fentanyl