title: Combination of pre-emptive port-site and intraoperative intraperitoneal ropivacaine for reduction of postoperative pain: a prospective cohort study.
abstract: OBJECTIVE
  To evaluate the effectiveness of intraoperatively applied local ropivacaine added to standard analgesic therapy in reducing postoperative pain intensity and opioid requirement under routine hospital conditions.
  
  
  METHODS
  In this prospective controlled cohort study, 303 consecutive patients receiving a gynaecological laparoscopic intervention at the Jena University Hospital were included. The study cohort (n=168) received, in addition to standard pain management, a port-site (PS) infiltration with ropivacaine prior to incision and intraperitoneal (IP) instillation at the end of surgery. On the first postoperative day patients answered a validated questionnaire, and requirement of rescue analgesics was assessed.
  
  
  RESULTS
  Pain intensity was assessed on an 11-point numeric rating scale (NRS) from 0=no pain to 10=most severe pain. Reported pain intensity for movement-related pain was significantly lower (p=.001) in the study group compared with the control group (4.4 (SD 2.4) vs. 5.3 (SD 2.2) respectively). Minimal pain intensity after operation was also significantly lower in the study cohort (2.6 (SD 1.7) vs. 2.1 (SD 1.8), (p=.007)). Significantly fewer patients required rescue opioids for analgesia in the ropivacaine cohort (p=.001). The requested dose of rescue opioid (piritramide) in this cohort was also lower (p=.035) with 6.5mg (SD 4.9) vs. 8.7mg (SD 6.6), and demanded later (p=.001) with 4.3h after surgery vs. 3.1h. Patients in the study cohort experienced less nausea (p=.046). Higher satisfaction scores with pain management were reported in the ropivacaine group 12.7 (SD 2.5) vs. 11.6 (SD 2.8) (p<.001) (16-point NRS with 0=not at all, 15=completely satisfied).
  
  
  CONCLUSIONS
  Addition of pre-emptive port-site plus intraperitoneal ropivacaine to standard postoperative analgesic therapy reduced postoperative pain intensity and opioid consumption in gynaecological laparoscopy.
authors: Department of Gynaecology and Obstetrics, Jena University Hospital, Friedrich-Schiller-University Jena, Bachstraße 18, Jena 07743, Germany.
authors: Jorge
authors: J
authors: Jiménez Cruz
authors: Department of Gynaecology and Obstetrics, Jena University Hospital, Friedrich-Schiller-University Jena, Bachstraße 18, Jena 07743, Germany.
authors: Herbert
authors: H
authors: Diebolder
authors: Department of Gynaecology and Obstetrics, Jena University Hospital, Friedrich-Schiller-University Jena, Bachstraße 18, Jena 07743, Germany.
authors: Askin
authors: A
authors: Dogan
authors: Department of Gynaecology and Obstetrics, Jena University Hospital, Friedrich-Schiller-University Jena, Bachstraße 18, Jena 07743, Germany.
authors: Anke
authors: A
authors: Mothes
authors: Department of Gynaecology and Obstetrics, Jena University Hospital, Friedrich-Schiller-University Jena, Bachstraße 18, Jena 07743, Germany.
authors: Mathias
authors: M
authors: Rengsberger
authors: Pharmacy, Jena University Hospital, Friedrich-Schiller-University Jena, Erlanger Allee 101, Jena 07747, Germany.
authors: Michael
authors: M
authors: Hartmann
authors: Department of Anaesthesiology and Intensive Care, Jena University Hospital, Friedrich-Schiller-University Jena, Erlanger Allee 101, Jena 07747, Germany.
authors: Winfried
authors: W
authors: Meissner
authors: Department of Gynaecology and Obstetrics, Jena University Hospital, Friedrich-Schiller-University Jena, Bachstraße 18, Jena 07743, Germany. Electronic address: ingo.runnebaum@med.uni-jena.
authors: Ingo B
authors: IB
authors: Runnebaum
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000577:Amides / Q000008:administration & dosage / Q000627:therapeutic use*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D000077212:Ropivacaine; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine
keywords: Gynaecologic laparoscopy; Intraperitoneal instillation; Local anaesthetics; Pain; Port-site infiltration; Ropivacaine