title: [Clinical significance of ropivacaine local infiltration for postoperative analgesia after total laparoscopic radical gastrectomy in elderly patients].
abstract: OBJECTIVE
  To explore the analgesic effects and postoperative recovery of ropivacaine incision infiltration in elderly patients after total laparoscopic radical gastrectomy.
  
  
  METHODS
  The clinical data were obtained prospectively from 61 elderly patients ( ≥ 65y) undergoing traditional total laparoscopic radical gastrectomy under standard general anesthesia at our department during January 2012 and September 2013. After surgery, they were randomly double-blindly divided into 3 groups: local infiltration of ropivacaine group (0.5% ropivacaine incision infiltration, 40 ml, n = 22), local infiltration of sodium chloride group (0.9% sodium chloride injection incision infiltration, 40 ml, n = 20) and control group (no analgesic, n = 19). The intensity of postoperative pain was evaluated by numeric rating scale (NRS). And 10 mg of morphine was administered intramuscularly as rescue medication when NRS exceeded 4.NRS, cases on remedy analgesia and associated side effects were observed and recorded after 6 h postoperatively. A comparative study was made for postoperative first ambulation time, intestinal function recovery time, complication incidence, postoperative hospital stay and medical expenses among three groups.
  
  
  RESULTS
  Significant postoperative difference existed in NRS at 6, 12, 24, 48 h among ropivacaine, sodium and control groups respectively (6 h: 2.65 ± 0.25 vs 5.47 ± 0.12 vs 5.63 ± 0.27, 12 h: 2.42 ± 0.34 vs 5.82 ± 0.63 vs 5.67 ± 0.49, 24 h: 2.27 ± 0.83 vs 3.95 ± 0.51 vs 3.84 ± 0.60, 48 h: 2.05 ± 0.90 vs 3.75 ± 0.72 vs 3.74 ± 0.56, P < 0.05) . The patients with ropivacaine local infiltration had a lower rate of remedy analgesia than those with sodium chloride injection incision infiltration or without analgesic (both P < 0.05). There was no obvious adverse effect of ropivacaine infiltration at 48 h postoperatively. Both postoperative first ambulation and peristalsis recovery time were shorter (P < 0.05) in ropivacaine group ((53 ± 9) and (80 ± 6) h) than sodium group ((91 ± 11) and (105 ± 9) h) and control group ((93 ± 11) and (109 ± 10) h) . Meanwhile, ropivacaine group had significance decreased postoperative hospital stay and medical expenses than that in local infiltration of sodium group and control group ((10.2 ± 1.3) vs (12.6 ± 1.3), (12.9 ± 1.6) days, (57 000 ± 5 000) vs (63 000 ± 6 000), (65 000 ± 6 000) yuan) (all P < 0.05). Occurrence of complications significantly differed among three groups (local infiltration of ropivacaine group 9.10% (2/22), local infiltration of sodium chloride group 25.00% (5/20) and control group 21.05% (4/19), P < 0.05).
  
  
  CONCLUSIONS
  Ropivacaine infiltration may reduce postoperative pain after total laparoscopic radical gastrectomy, enable faster recovery and provide an alternative analgesia in elderly patients.
authors.affiliation: Department of Gastrointestinal Surgery, First Affiliated Hospital, Xiamen University & Xiamen Cancer Center, Xiamen 361003, China.
authors.forename: Zhengjie
authors.initials: Z
authors.lastname: Huang
authors.affiliation: Department of Gastrointestinal Surgery, First Affiliated Hospital, Xiamen University & Xiamen Cancer Center, Xiamen 361003, China.
authors.forename: Yongjin
authors.initials: Y
authors.lastname: Xie
authors.affiliation: Department of Gastrointestinal Surgery, First Affiliated Hospital, Xiamen University & Xiamen Cancer Center, Xiamen 361003, China.
authors.forename: Jun
authors.initials: J
authors.lastname: You
authors.affiliation: Department of Gastrointestinal Surgery, First Affiliated Hospital, Xiamen University & Xiamen Cancer Center, Xiamen 361003, China.
authors.forename: Lin
authors.initials: L
authors.lastname: Xu
authors.affiliation: Department of Gastrointestinal Surgery, First Affiliated Hospital, Xiamen University & Xiamen Cancer Center, Xiamen 361003, China.
authors.forename: Yueda
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Department of Gastrointestinal Surgery, First Affiliated Hospital, Xiamen University & Xiamen Cancer Center, Xiamen 361003, China.
authors.forename: Baisheng
authors.initials: B
authors.lastname: Chen
authors.affiliation: Department of Gastrointestinal Surgery, First Affiliated Hospital, Xiamen University & Xiamen Cancer Center, Xiamen 361003, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Wei
authors.affiliation: Department of Gastrointestinal Surgery, First Affiliated Hospital, Xiamen University & Xiamen Cancer Center, Xiamen 361003, China. Email: luoqixmzsh@126.com.
authors.forename: Qi
authors.initials: Q
authors.lastname: Luo
mesh_terms: D000368:Aged; D000577:Amides / Q000008:administration & dosage / Q000627:therapeutic use*; D000698:Analgesia; D000700:Analgesics / Q000008:administration & dosage / Q000627:therapeutic use*; D005743:Gastrectomy; D006801:Humans; D010535:Laparoscopy; D059408:Pain Management; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D000077212:Ropivacaine; D016896:Treatment Outcome
chemical_list: D000577:Amides; D000700:Analgesics; D000077212:Ropivacaine