Pre-emptive intraperitoneal local anaesthesia: an effective method in immediate post-operative pain management and metabolic stress response in laparoscopic appendicectomy, a randomized, double-blinded, placebo-controlled study.
BACKGROUND
Although laparoscopic surgeries are associated with reduced surgical stress response and shortened post-operative recovery, intense pain and high analgesia requirements in the immediate post-operative period are often the chief complaints.


OBJECTIVE
The aim of this study was to evaluate the effect of pre-emptive intraperitoneal local anaesthetic drugs on post-operative pain management and metabolic stress response in laparoscopic appendicectomy.


METHODS
The method used was a randomized double-blinded placebo-controlled study. Patients with clinical diagnosis of acute appendicitis who fulfil the criteria, were taken into this study. Primary outcomes investigated were consumption of patient-controlled analgesia during the immediate post-operative period (first 6 h) and subsequent 18 h as well as serum cortisol sampling.


RESULTS
Total of 120 patients were recruited into three different treatment groups (placebo, ropivacaine, levobupivacaine). In order to maintain visual analogue score of 0-1 during the immediate post-operative period, patients in the placebo group required significantly (P < 0.001) higher dose of analgesia (morphine/mg) - 11 mg (8.3-15.5) as compared with ropivacaine - 4 mg (3.0-6.0) and levobupivacaine - 3.5 mg (2.0-5.0). The immediate post-operative serum cortisol showed a significant increase in serum cortisol in the placebo group (P = 0.001) as compared with ropivacaine and levobupivacaine groups.


CONCLUSIONS
Pre-emptive intraperitoneal local anaesthesia in laparoscopy surgery is a safe, non-invasive procedure that can benefit patients by reducing the immediate post-operative pain intensity and metabolic stress response of the body.
Department of Surgery, Tuanku Ja'afar Hospital, Seremban, Negeri Sembilan, Malaysia; Department of Surgery, University of Malaya Medical Centre, Kuala Lumpur, Malaysia.
Mohana Raj
MR
Thanapal
Mahadevan D
MD
Tata
Ann J
AJ
Tan
Thiruselvi
T
Subramaniam
Jenny M G
JM
Tong
Kandasami
K
Palayan
Sanjay
S
Rampal
Ramesh
R
Gurunathan
D000328:Adult; D000577:Amides / Q000008:administration & dosage; D016058:Analgesia, Patient-Controlled / Q000706:statistics & numerical data; D000772:Anesthesia, Local / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001062:Appendectomy / Q000379:methods*; D001064:Appendicitis / Q000601:surgery*; D015415:Biomarkers / Q000097:blood; D002045:Bupivacaine / Q000008:administration & dosage / Q000031:analogs & derivatives; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007263:Infusions, Parenteral; D010535:Laparoscopy; D000077554:Levobupivacaine; D008297:Male; D010147:Pain Measurement; D010149:Postoperative Pain / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy / Q000517:prevention & control*; D000077212:Ropivacaine; D013312:Stress, Physiological; D016896:Treatment Outcome
D000577:Amides; D000779:Anesthetics, Local; D015415:Biomarkers; D000077212:Ropivacaine; D000077554:Levobupivacaine; D006854:Hydrocortisone; D002045:Bupivacaine