title: Intraperitoneal ropivacaine nebulization for pain management after laparoscopic cholecystectomy: a comparison with intraperitoneal instillation.
abstract: BACKGROUND
  Studies evaluating intraperitoneal local anesthetic instillation for pain relief after laparoscopic procedures have reported conflicting results. In this randomized, double-blind study we assessed the effects of intraperitoneal local anesthetic nebulization on pain relief after laparoscopic cholecystectomy.
  
  
  METHODS
  Patients undergoing elective laparoscopic cholecystectomy were randomly assigned to receive either instillation of ropivacaine 0.5%, 20 mL after induction of the pneumoperitoneum, or nebulization of ropivacaine 1%, 3 mL before and after surgery. Anesthetic and surgical techniques were standardized. Degree of pain at rest and on deep breathing, incidence of shoulder pain, morphine consumption, unassisted walking time, and postoperative nausea and vomiting were evaluated at 6, 24, and 48 hours after surgery.
  
  
  RESULTS
  Of the 60 patients included, 3 exclusions occurred for conversion to open surgery. There were no differences between groups in pain scores or in morphine consumption. No patients in the nebulization group presented significant shoulder pain in comparison with 83% of patients in the instillation group (absolute risk reduction -83, 95% CI -97 to -70, P<0.001). Nineteen (70%) patients receiving nebulization walked without assistance within 12 hours after surgery in comparison with 14 (47%) patients receiving instillation (absolute risk reduction -24, 95% CI -48 to 1, P=0.04). One (3%) patient in the instillation group vomited in comparison with 6 (22%) patients in the nebulization group (absolute risk reduction -19%, 95% CI -36 to -2, P=0.03).
  
  
  CONCLUSIONS
  Intraperitoneal ropivacaine nebulization was associated with reduced shoulder pain and unassisted walking time but with an increased incidence of postoperative vomiting after laparoscopic cholecystectomy.
authors.affiliation: U.O. Anestesia e Rianimazione I, Ospedale San Gerardo di Monza, and Dipartimento di Medicina Sperimentale, Università Milano Bicocca, Via Pergolesi 33, 20900 Monza, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Bucciero
authors.forename: Pablo M
authors.initials: PM
authors.lastname: Ingelmo
authors.forename: Roberto
authors.initials: R
authors.lastname: Fumagalli
authors.forename: Eric
authors.initials: E
authors.lastname: Noll
authors.forename: Andrea
authors.initials: A
authors.lastname: Garbagnati
authors.forename: Marta
authors.initials: M
authors.lastname: Somaini
authors.forename: Girish P
authors.initials: GP
authors.lastname: Joshi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Vitale
authors.forename: Vittorio
authors.initials: V
authors.lastname: Giardini
authors.forename: Pierre
authors.initials: P
authors.lastname: Diemunsch
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000577:Amides / Q000008:administration & dosage* / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000762:Anesthesia Recovery Period; D000768:Anesthesia, General; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000627:therapeutic use*; D017081:Cholecystectomy, Laparoscopic; D004311:Double-Blind Method; D004434:Early Ambulation; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D007263:Infusions, Parenteral; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use; D009330:Nebulizers and Vaporizers; D010147:Pain Measurement / Q000187:drug effects; D010149:Postoperative Pain / Q000188:drug therapy*; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology; D000077212:Ropivacaine; D020069:Shoulder Pain / Q000517:prevention & control; D055815:Young Adult
chemical_list: D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D009020:Morphine; D000077212:Ropivacaine