title: Postoperative Analgesia after Laparoscopic Ovarian Cyst Resection: Double-blind Multicenter Randomized Control Trial Comparing Intraperitoneal Nebulization and Peritoneal Instillation of Ropivacaine.
abstract: OBJECTIVE
  To compare the effects of local anesthetic intraperitoneal nebulization with intraperitoneal instillation during laparoscopic ovarian cystectomy on postoperative morphine consumption and pain.
  
  
  METHODS
  Multicenter, randomized, case-control trial.
  
  
  METHODS
  Canadian Task Force Classification I.
  
  
  METHODS
  University hospitals in Italy.
  
  
  METHODS
  One hundred forty patients scheduled for laparoscopic ovarian cystectomy.
  
  
  METHODS
  Patients were randomized to receive either nebulization of ropivacaine 150 mg before surgery or instillation of ropivacaine 150 mg before surgery. Nebulization was performed using the Aeroneb Pro device (Aerogen, Galway, Ireland).
  
  
  RESULTS
  One hundred forty patients were enrolled, and 123 completed the study. There was no difference between the 2 groups in average morphine consumption (7.3 ± 7.5 mg in the nebulization group vs 9.2 ± 7.2 mg in the instillation group; p = .17). Eighty-two percent of patients in the nebulization group required morphine compared with 96% in the instillation group (p < .05). Patients receiving nebulization had a lower dynamic Numeric Ranking Scale compared with those in the instillation group in the postanesthesia care unit postanesthesia care unit and 4 hours after surgery (p < .05). Ten patients (15%) in the nebulization group experienced shivering in the postanesthesia care unit compared with 2 patients (4%) in the instillation group (p = .035).
  
  
  CONCLUSIONS
  Nebulization of ropivacaine prevents the use of morphine in a significant proportion of patients, reduced postoperative pain during the first hours after surgery, and was associated with a higher incidence of postoperative shivering when compared with instillation.
authors.affiliation: U.O. Anestesia e Rianimazione, Ospedale San Gerardo di Monza, Università di Milano-Bicocca, Milan, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Scalia Catenacci
authors.affiliation: U.O. Anestesia e Rianimazione, Ospedale San Gerardo di Monza, Università di Milano-Bicocca, Milan, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Lovisari
authors.affiliation: McGill University Health Centre, McGill University, Montreal, Quebec, Canada.
authors.forename: Shuo
authors.initials: S
authors.lastname: Peng
authors.affiliation: Anesthesia and Pain Unit, Department of Surgical Science, Azienda Ospedaliera, University of Parma, Parma, Italy; Anesthesia Intensive Care and Pain Therapy Service, Azienda Ospedaliera, University of Parma, Parma, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Allegri
authors.affiliation: U.O. Anestesia e Rianimazione I, Ospedale Niguarda Ca' Granda, Università di Milano-Bicocca, Milan, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Somaini
authors.affiliation: U.O. Anestesia e Rianimazione, Ospedale San Gerardo di Monza, Università di Milano-Bicocca, Milan, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Ghislanzoni
authors.affiliation: U.O. Anestesia e Rianimazione 2, Dipartimento Neuroscienze, Azienda Ospedaliera Ospedale di Lecco, Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Greco
authors.affiliation: Università di Milano-Bicocca, Milan, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Rossini
authors.affiliation: U.O. Anestesia e Rianimazione, Ospedale San Gerardo di Monza, Università di Milano-Bicocca, Milan, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: D'Andrea
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. Ostetricia e Ginecologia, Azienda Ospedaliera Ospedale di Lecco, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Pellegrino
authors.affiliation: Department of Anesthesia and Intensive Care, IRCCS Foundation, Policlinico San Matteo, Pavia, Italy.
authors.forename: Debora
authors.initials: D
authors.lastname: Sportiello
authors.affiliation: Department of Anesthesia and Intensive Care, IRCCS Foundation, Policlinico San Matteo, Pavia, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Bugada
authors.affiliation: McGill University Health Centre, McGill University, Montreal, Quebec, Canada; Montreal Children's Hospital and Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec, Canada. Electronic address: pablo.ingelmo@mcgill.ca.
authors.forename: Pablo M
authors.initials: PM
authors.lastname: Ingelmo
mesh_terms: D000328:Adult; D000577:Amides / Q000008:administration & dosage*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects; D006801:Humans; D007274:Injections, Intraperitoneal; D010535:Laparoscopy / Q000009:adverse effects; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage*; D009330:Nebulizers and Vaporizers; D010048:Ovarian Cysts / Q000150:complications / Q000601:surgery*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy* / Q000209:etiology; D000077212:Ropivacaine; D016896:Treatment Outcome
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D009020:Morphine; D000077212:Ropivacaine
keywords: Acute pain, regional techniques; Analgesics, postoperative; Anesthetic techniques, insuffiation; Anesthetic techniques, regional; Local anesthetics, ropivacaine