title: Aerosolized intraperitoneal local anesthetic for laparoscopic surgery: a randomized, double-blinded, placebo-controlled trial.
abstract: BACKGROUND
  Postoperative pain remains a significant challenge following laparoscopy. Aerosolized intraperitoneal local anesthetic (AILA) is a novel method to deliver local anesthetic. The aim was to evaluate aerosolized ropivacaine in pain management following laparoscopic Nissen fundoplication (LNF) and cholecystectomy (LC).
  
  
  METHODS
  This prospective randomized double-blinded placebo-controlled trial enrolled consecutive patients undergoing LNF and LC. The treatment group (TG) received intraperitoneal ropivacaine (5 mL 1 % Naropin(®)) at CO2 insufflation via the AeroSurge(®) aerosolizer device through the camera port. The control group (CG) received 5 mL of saline in the same manner. Postoperative shoulder tip pain at rest 6 h postoperatively was the primary study endpoint, with secondary endpoints of shoulder and abdominal pain within the first 24 h, recovery room stay, hospital stay, and postoperative analgesia use. Pain scores were collected using the Verbal Rating Score.
  
  
  RESULTS
  Eighty-seven patients were included in the final analysis (TG n = 40, CG n = 47). There was no significant difference between CG and TG at the primary endpoint. In the LC group, AILA significantly reduced shoulder tip pain at rest at 10 (p = 0.030) and 30 min (p = 0.040) and shoulder tip pain on movement at 10 (p = 0.030) and 30 min (p = 0.037). In the LNF group, AILA significantly reduced postoperative abdominal pain at rest at 6 h (p = 0.009). AILA reduced overall incidence of shoulder tip pain in the LC group (11.8 vs. 57.9 %, p = 0.004).
  
  
  CONCLUSIONS
  This study did not demonstrate a significant difference between TG and CG in the primary endpoint, pain at 6 h postoperatively.
authors: Discipline of Surgery, National University of Ireland, Galway, Ireland, ailbhemcdermott@gmail.com.
authors: Ailbhe M
authors: AM
authors: McDermott
authors: Kah Hoong
authors: KH
authors: Chang
authors: Kelly
authors: K
authors: Mieske
authors: Peter F
authors: PF
authors: McAnena
authors: Brian
authors: B
authors: Kinirons
authors: Abdelaly
authors: A
authors: Abeidi
authors: Brian H
authors: BH
authors: Harte
authors: Michael J
authors: MJ
authors: Kerin
authors: Oliver J
authors: OJ
authors: McAnena
mesh_terms: D015746:Abdominal Pain / Q000209:etiology / Q000517:prevention & control; D000328:Adult; D000336:Aerosols; D000577:Amides / Q000008:administration & dosage*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D004311:Double-Blind Method; D005260:Female; D018662:Fundoplication / Q000009:adverse effects*; D006801:Humans; D007327:Insufflation; D010535:Laparoscopy / Q000009:adverse effects; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D011446:Prospective Studies; D000077212:Ropivacaine; D020069:Shoulder Pain / Q000209:etiology / Q000517:prevention & control
chemical_list: D000336:Aerosols; D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine
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