title: Effects of peritoneal ropivacaine nebulization for pain control after laparoscopic gynecologic surgery.
abstract: OBJECTIVE
  To evaluate the effects of peritoneal cold nebulization of ropivacaine on pain control after gynecologic laparoscopy.
  
  
  METHODS
  Evidence obtained from a properly designed, randomized, double-blind, placebo-controlled trial (Canadian Task Force classification I).
  
  
  METHODS
  Tertiary care center.
  
  
  METHODS
  One hundred thirty-five women with American Society of Anesthesiologists disease classified as ASA I-III who were scheduled to undergo operative laparoscopy.
  
  
  METHODS
  Patients were randomized to receive either nebulization of 30 mg ropivacaine before surgery (preoperative group), nebulization of 30 mg ropivacaine after surgery (postoperative group), instillation of 100 mg ropivacaine before surgery (instillation group), or instillation of saline solution (control group). Nebulization was performed using the Aeroneb Pro device.
  
  
  RESULTS
  Pain scores, morphine consumption, and ambulation time were collected in the post-anesthesia care unit and at 4, 6, and 24 hours postoperatively. One hundred eighteen patients completed the study. Patients in the preoperative group reported lower pain Numeric Ranking Scale values compared with those in the control group (net difference 2 points; 95% confidence interval [CI], 0.3-3.1 at 4 hours, 1-3 at 6 hours, and 0.7-3 at 24 hours; p = .01) Patients in the preoperative group consumed significantly less morphine than did those in the control group (net difference 7 mg; 95% CI, 0.7-13; p = .02). More patients who received nebulization walked without assistance within 12 hours after awakening than did those in the instillation and control groups (net difference 15%; 95% CI, 6%-24%; p = .001).
  
  
  CONCLUSIONS
  Cold nebulization of ropivacaine before surgery reduced postoperative pain and morphine consumption and was associated with earlier walking without assistance.
authors.affiliation: U.O. Anestesia e Rianimazione 1, Ospedale Niguarda Ca' Granda, Milan, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Somaini
authors.affiliation: U.O. Anestesia e Rianimazione I, Ospedale Riuniti di Bergamo, Bergamo, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Brambillasca
authors.affiliation: McGill University Health Centre, Montreal Children's Hospital, Montreal, Canada. Electronic address: pablo.ingelmo@muhc.mcgill.ca.
authors.forename: Pablo Mauricio
authors.initials: PM
authors.lastname: Ingelmo
authors.affiliation: U.O. Anestesia e Rianimazione, Ospedale San Gerardo, Monza, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Lovisari
authors.affiliation: U.O. Anestesia e Rianimazione, Ospedale San Gerardo, Monza, Italy.
authors.forename: Stefano Scalia
authors.initials: SS
authors.lastname: Catenacci
authors.affiliation: Università degli Studi Milano Bicocca, Milan, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Rossini
authors.affiliation: Service d'Anesthésie Réanimation, Hôpital Lariboisière, Paris, France.
authors.forename: Mario
authors.initials: M
authors.lastname: Bucciero
authors.affiliation: Department of Anesthesia and Intensive Care, Kozyatağı Acıbadem Hospital, İstanbul, Turkey.
authors.forename: Emre
authors.initials: E
authors.lastname: Sahillioglu
authors.affiliation: U.O. Ginecologia e Ostetricia, Ospedale San Gerardo, Monza, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Buda
authors.affiliation: U.O. Ginecologia e Ostetricia, Ospedale San Gerardo, Monza, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Signorelli
authors.affiliation: U.O. Anestesia e Rianimazione, Ospedale San Gerardo, Monza, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Gili
authors.affiliation: Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Girish
authors.initials: G
authors.lastname: Joshi
authors.affiliation: U.O. Anestesia e Rianimazione 1, Ospedale Niguarda Ca' Granda, Milan, Italy; Università degli Studi Milano Bicocca, Milan, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Fumagalli
authors.affiliation: McGill University Health Centre, Montreal Children's Hospital, Montreal, Canada.
authors.forename: Catherine E
authors.initials: CE
authors.lastname: Ferland
authors.affiliation: Service d'Anesthésiologie-Réanimation Chirurgicale, CHU de Hautepierre, and EA 3072, Faculté de Médecine, Strasbourg, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Diemunsch
mesh_terms: D000328:Adult; D000577:Amides / Q000008:administration & dosage*; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D004311:Double-Blind Method; D004434:Early Ambulation; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects; D006801:Humans; D007263:Infusions, Parenteral; D010535:Laparoscopy / Q000009:adverse effects; D009020:Morphine / Q000008:administration & dosage*; D009330:Nebulizers and Vaporizers; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy / Q000517:prevention & control*; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control*; D000077212:Ropivacaine; D016896:Treatment Outcome
chemical_list: D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D009020:Morphine; D000077212:Ropivacaine
keywords: Acute pain; Anesthetic techniques; Insufflation; Local anesthetics; Postoperative; Regional analgesics; Regional techniques; Ropivacaine