Intraperitoneal Instillation Of Ropivacaine Research Articles

Efficacy and safety of intraperitoneal ropivacaine in pain management following laparoscopic digestive surgery: A systematic review and meta-analysis of RCTs.

Managing postoperative pain effectively with an opioid-free regimen following laparoscopic surgery (LS) remains a significant challenge. Intraperitoneal instillation of ropivacaine has been explored for its potential to reduce acute postoperative pain, but its efficacy and safety are still under debate. This study aimed to evaluate the efficacy and safety of intraperitoneal instillation of ropivacaine for acute pain management following laparoscopic digestive surgery. We used PRISMA 2020 and a measurement tool to assess systematic reviews 2 guidelines to conduct this review. The random-effects model was adopted using Review Manager Version 5.4 for pooled estimates. We retained 24 eligible RCTs involving 1705 patients (862 patients in the intraperitoneal instillation group and 843 patients in the control group). The intraperitoneal instillation group reduced total opioid consumption during the first 24 hours postoperatively (MD = -21.93 95% CI [-27.64, -16.23], P < .01), decreased pain scores at different time (4 hours, 8 hours, 12 hours and 24 hours), shorter the hospital stay (MD = -0.20 95% CI [-0.36, -0.05], P < .01), reduced the postoperative shoulder pain (MD = 0.18 95% CI [0.07, 0.44], P < .01), and decreased postoperative nausea and vomiting (MD = 0.47 95% CI [0.29, 0.77], P < .01). Intraperitoneal instillation of ropivacaine appears to be an effective component of multimodal pain management strategies following laparoscopic digestive surgery, significantly reducing opioid consumption and improving postoperative recovery markers. Despite these promising results, additional high-quality trials are needed to confirm the efficacy and safety of this approach. The registration number at PROSPERO was CRD42021279238.

Peri-Incisional Infiltration and Intraperitoneal Instillation of Local Anesthetic for Reducing Pain After Laparoscopic Donor Nephrectomy: A Prospective, Randomized, Double-Blind Control Trial

The analgesic efficacy of peri-incisional infiltration and intraperitoneal instillation of ropivacaine in laparoscopic donor nephrectomy has not been clearly established. This randomized, controlled, double-blind trial allocated living donors undergoing left-sided laparoscopic donor nephrectomy to one of the following 4 groups: peri-incisional normal saline (NS) and intraperitoneal NS (group A, n=30), peri-incisional 0.375% ropivacaine and intraperitoneal NS (group B, n=31), peri-incisional NS and intraperitoneal 0.15% ropivacaine (group C, n=31), and peri-incisional 0.375% and intraperitoneal 0.15% ropivacaine (group D, n=32). Pain status was assessed using the visual analog scale at rest and during coughing at 2, 12, 24, and 48 hours postoperatively. Patient-controlled analgesia and additional rescue analgesic consumption were calculated by conversion to an equivalent dosage of morphine. This study did not include prisoners or those individuals who were coerced or paid as study participants. The patient demographics and perioperative outcomes, including operative time, blood loss, and incision length, were comparable between the groups. The pain scores and number of patients who experienced shoulder pain at all postoperative time points did not differ significantly among the 4 groups. Postoperative analgesic consumption was similar in all groups, and there was no difference in the length of hospital stay. Peri-incisional infiltration and intraperitoneal instillation of ropivacaine did not reduce postoperative pain or analgetic consumption.

Efficacy of intravenous dexmedetomidine versus intraperitoneal dexmedetomidine in laparoscopic cholecystectomy – A prospective randomized double-blinded study

Background: Dexmedetomidine now has become one of the frequently used drugs as part of a multimodal analgesic regimen to provide improved pain control at all perioperative stages for laparoscopic surgeries. Aims and Objectives: In this prospective, double-blind, randomized, and control trial, we compared the postoperative analgesic efficacy of intravenous (IV) dexmedetomidine and intraperitoneal (IP) dexmedetomidine in laparoscopic cholecystectomy. Materials and Methods: Sixty patients of the American Society of Anesthesiologists Grade I and II undergoing laparoscopic cholecystectomy were allocated into two groups. The patients in Group-IV had received 30 ml of 0.5 μg/kg Dexmedetomidine infusion intravenously plus 40 ml of Ropivacaine (30 mL of 0.5% Ropivacaine and 10 ml NS) intraperitoneally and in Group-IP received 30 ml NS intravenously and 40 ml of Ropivacaine plus Dexmedetomidine (30 mL of 0.5% Ropivacaine and 0.5 μg/kg Dexmedetomidine diluted in 10 ml NS) intraperitoneally after removal of the gallbladder. Patients were assessed during the first 24 h postoperatively for time to the first requirement of analgesia, total analgesic consumption, sedation, hemodynamics, side effects, and patient satisfaction. Results: Time to first request of analgesia (min) was longer (216.46±42.19 vs. 108.03±48.77) and total analgesic consumption (mg) was lower (92.50±32.26 vs 115.0±38.056) in Group-IV than in Group-IP. A significant difference was observed in visual analogue score in Group-IV at 1 h, 2 h, 4 h postoperatively and in the patient satisfaction score (P=0.024) in comparison to Group-IP. Conclusion: The postoperative analgesic effects and patient satisfaction, of low dose IV Dexmedetomidine plus IP instillation of Ropivacaine, are superior to low dose IP Dexmedetomidine added to Ropivacaine.

Intraperitoneal Instillation of Local Anesthetic (IPILA) in Bariatric Surgery and the Effect on Post-operative Pain Scores: a Randomized Control Trial

BackgroundEffective analgesia after bariatric procedures is vital as it can reduce post-operative opioid use. This leads to less nausea which may be associated with shorter post-operative length of stay (LOS). Understanding analgesic requirements in patients with obesity is important due to the varied physiology and increased number of comorbidities.ObjectivesThe aim of this study was to evaluate the efficacy of intraperitoneal instillation of local anesthetic (IPILA) to reduce opioid requirements in patients undergoing laparoscopic bariatric surgery.MethodsA double-blinded randomized control trial was conducted to compare intraperitoneal instillation of ropivacaine to normal saline in 104 patients undergoing bariatric surgery. The primary endpoint was pain in recovery with secondary endpoints at 1, 2, 4, 6, 24, and 48 h post-operatively. Further endpoints were post-operative analgesic use and LOS. Safety endpoints included unexpected reoperation or readmission, complications, and mortality.ResultsThere were 54 patients in the placebo arm and 50 in the IPILA. Pain scores were significantly lower in the IPILA group both at rest (p = 0.04) and on movement (p = 0.02) in recovery with no difference seen at subsequent time points. Equally, IPILA was independently associated with reducing severe post-operative pain at rest and movement (adjusted odds ratio [aOR] 0.28, 95% CI 0.11–0.69, p = 0.007 and aOR 0.25, 95% CI 0.09–0.62, p = 0.004, respectively). There was no significant difference in LOS, opioid use, antiemetic use, morbidity, or mortality between the intervention and placebo groups.ConclusionThe administration of ropivacaine intraperitoneally during laparoscopic bariatric surgery reduces post-operative pain in the recovery room but does not reduce opioid use nor LOS.

Observational study to compare the efficacy of Intraperitoneal Ropivacaine with dexmedetomidine versus fentanyl for postoperative analgesia in patients undergoing laparoscopic cholecystectomy

Intraperitoneal instillation of local anaesthetics with adjuvant has been used to control postoperative pain after laproscopic cholecystectomy. Aim: Compare efficacy of intraperitoneal ropivacaine with dexmedetomidine/fentanyl for postoperative analgesia in patients undergoing laparoscopic cholecystectomy. Methods: After obtaining ethical committee approval and informed consent, 62 patients aged 18-60 years, ASA I&amp;II were divided into two groups; Group D: 18ml ropivacaine0.75% with 1µg/kg dexmedetomidine (2ml),Group F: 18ml ropivacaine0.75% with 1µg/kg fentanyl (2ml), instilled intraperitoneally after dissection of gallbladder in gallbladder fossa. Hemodynamic parameters were noted 1minute after instillation and every 15 minutes till 1hour and every hourly till 6hrs. Post-operative analgesia assessed by VAS score 1/2 hourly till 1hr and then hourly till VAS≥4 was reached. Results: Hemodynamic parameters were significantly lower in Group D upto 6hrs after instillation (p&lt;0.05) and VAS was lower in Group D till 8hrs(p&lt;0.05) post instillation as compared to group F. The duration of postoperative analgesia in Group D was 6.9±1.42 hours which was significantly longer than Group F was 3.41±0.84 hours,(p=0.001). Conclusion: Intraperitoneal instillation of ropivacaine with dexmedetomidine is more effective for post operative analgesia than ropivacaine with fentanyl for patients undergoing laproscopic cholecystectomy.

Perioperative management of acute pain by multimodal analgesia after laparoscopic sleeve gastrectomy: A prospective cohort study

BackgroundBariatric surgery has been shown to be the most effective treatment in achieving and maintaining weight loss and reducing obesity-related morbidities. Adequate measurement and control of pain allows for better postoperative outcomes and substantial reduction of complications, especially in subjects with morbid obesity. The aim of this study was to investigate the efficacy of postoperative analgesia via the utilization of a multimodal approach and to determine predictors of postoperative pain severity in patients undergoing laparoscopic sleeve gastrectomy (LSG). MethodsThis is a prospective cohort study designed to evaluate a perioperative multimodal analgesia protocol (i.e. subcutaneous/subfascial and intraperitoneal instillation of Ropivacaine; nonsteroidal anti-inflammatory agents; paracetamol and minimal dose of oral opioids) in subjects undergoing LSG. Evaluation of postoperative analgesia was performed at 1, 4 and 24 h after surgery through employment of chromatic visual analogue scales (VAS). ResultsBetween February and June 2019, a total of 48 consecutive patients affected by morbid obesity (mean BMI 41.83±5.51 kg/m2) underwent LSG. Mean operative time was 106±31.56 min. Only 8 patients (16.6%) required Morphine rescue in order to bring VAS at rest to ≤5. Pearsons’ coefficient showed a negative pCO2 correlation before surgery and both VAS scores measured at rest and during activity at different time points. P/F ratio and pCO2 measured before surgery were strong predictors of VAS >5 at rest and during activity (AUC=0.981 and AUC=0.980, respectively). ConclusionsThe identification of pain predictors could aid in foreseeing those patients requiring supplementary analgesia. Hence, a tailored analgesia protocol could be performed for each patient, improving pain management and perioperative outcomes. A multimodal analgesic protocol appears to represent the gold standard in the treatment of acute postoperative pain, especially in patients with morbid obesity, who require a rapid retrieval of physiologic functions in order to reduce the risk of postoperative complications.

Post-operative analgesic effect of intraperitoneal ropivacaine with or without tramadol in laparoscopic cholecystectomy.

Background and Aims:Intraperitoneal instillation of local anaesthetics has been shown to minimise post-operative pain after laparoscopic surgery. This study was aimed to evaluate the post-operative effect of intraperitoneal ropivacaine with and without tramadol in patients undergoing laparoscopic cholecystectomy.Methods:Eighty patients undergoing laparoscopic cholecystectomy were randomised into two groups. Group R received 0.5% ropivacaine 18 mL with normal saline (NS) 2 mL and Group RT received 0.5% ropivacaine 18 mL with tramadol (100 mg, 2 mL) at the end of surgery intraperitoneally through the port. The pain score was monitored using a numerical rating scale (NRS) every 30 min till 4 h post-operatively and then at 6 h, 12 h and 24 h. The primary objective of the study was to compare the severity of pain between the groups. The secondary objectives were to compare the total dose of rescue analgesic and the time tofirst rescue analgesia between the groups Statistical analysis was performed using statistical package for the social sciences. Chi-square test and Mann Whitney U test were used for analysis.Results:The pain score in Group RT was significantly lower than Group R at 2.5 h to 24 h (P = 0.005). Only 42.5% in Group RT demanded rescue analgesia as compared to 75% in Group R (P = 0.003). Total analgesic consumption of fentanyl was also reduced in the tramadol group (785 μg vs 1800 μg). No significant adverse effects were found.Conclusion:Intraperitoneal instillation of ropivacaine with tramadol reduces the post-operative pain and analgesic requirement in laparoscopic cholecystectomy as compared to ropivacaine alone.

A study to compare the effect of postoperative analgesia between intraperitoneal instillation of ropivacaine and bupivacaine in laparoscopic surgeries

A study to compare the effect of postoperative analgesia between intraperitoneal instillation of ropivacaine and bupivacaine in laparoscopic surgeries

Preemptive Analgesia by Intraperitoneal Instillation of Ropivacaine in Laparoscopic Cholecystectomy.

Background:Preemptive analgesia has the potential to be more effective than a similar analgesic treatment initiated after surgery as it reduces immediate postoperative pain as well as chronic pain.Aim:To study the efficacy of preemptive analgesia with intraperitoneal instillation of ropivacaine in laparoscopic cholecystectomy (LC).Materials and Methods:This prospective randomized double-blind study was conducted on patients undergoing LC. Hundred patients were randomly divided into two groups of fifty each. In Group A, patients received 3 mg/kg of ropivacaine intraperitoneal instillation in 100 ml normal saline (NS) before creation of pneumoperitoneum and in Group B patients received 3 mg/kg of ropivacaine intraperitoneal instillation in 100 ml NS after completion of surgery. Postoperative visual analog scale score for abdominal and shoulder tip pain alongwith requirement of rescue analgesic were recorded for 24 h.Results:Significantly lower visual analog scores for pain were observed in Group A versus Group B. Group A reported significantly lower pain at 0 h (P < 0.001), 1 h (P = 0.003), 3 h (P = 0.006), 6 h (P = 0.003), and 12 h (P = 0.001) postoperatively, but the difference was not statistically significant after 12 h. The mean time of first rescue analgesic was 472.8 ± 26.32 min in Group A, as compared with 189 ± 11.87 min in Group B. A significantly lower analgesic requirement was observed in Group A versus Group B throughout the entire study period (P < 0.05).Conclusion:The preemptive analgesia with intraperitoneal instillation of ropivacaine before creation of pneumoperitoneum is much more effective for postoperative pain relief in comparison to intraperitoneal instillation of ropivacaine after completion of surgery.

Comparison of Efficacy of Intraperitoneal Instillation of Ropivacaine with Ropivacaine Dexmedetomidine Combination for Post-Operative Analgesia Following Laparoscopic Cholecystectomy

Comparison of Efficacy of Intraperitoneal Instillation of Ropivacaine with Ropivacaine Dexmedetomidine Combination for Post-Operative Analgesia Following Laparoscopic Cholecystectomy

Intraperitoneal Instillation of Ropivacaine for Postoperative Pain Relief in Laparoscopic Cholecystectomy in a Comorbid Patient

We report a case of a 55-year-old female diagnosed with multiple gallbladder stones posted for laparoscopic cholecystectomy. Her comorbidities included obesity, diabetes, previous spinal surgery, chronic renal dysfunction with abnormal renal profile. She was also anxious about postoperative pain. The surgery was successfully completed under general anesthesia with intraperitoneal instillation of ropivacaine which was done just before creation of pneumoperitoneum, which also provided excellent postoperative analgesia, good intraoperative conditions with least hemodynamic alterations in a high-risk case where other modalities for postoperative pain relief had their own limitations.

English

Introduction Surgical procedures have been improved to reduce trauma, morbidity, mortality and hospital stay, with consequent reduction in healthcare costs. Patients undergoing laparoscopic procedures do experience postoperative pain, especially in upper and lower abdomen and back and shoulder regions. Intraperitoneal injections of local anaesthetic have been proposed to minimize postoperative pain after laparoscopic surgery. Therefore, this randomized, placebocontrolled study was conducted to compare the effectiveness of intraperitoneal ropivacaine with or without fentanyl for postoperative analgesia after laparoscopic surgery. Materials and methods Patients were randomized into three groups (n = 50) using a computergenerated table of random numbers. All surgeries were carried out under general anaesthesia, and patients were instructed preoperatively about grading the intensity of pain in the postoperative period as per visual analogue scale and verbal rating scale. The drug was injected intraperitoneally before the removal of trocar at the end of surgery. Results Visual analogue scale scores immediately postoperatively were 44.00 ± 19.16 (vs 22.20 ± 5.06 vs 23.20 ± 8.67; p < 0.001) and at 6th hour 35.40 ± 9.52 (vs 29.40 ± 4.24 vs 27.80 ± 5.0; p < 0.001). Similarly, verbal rating scale score (2.60 ± 0.88 vs 1.96 ± 0.74 vs 1.62 ± 0.56) was signiϐicantly reduced immediately postoperatively in Group 3. At the 6th hour verbal rating scale scores were 2.32 ± 0.79 vs 1.94 ± 0.42 vs 1.80 ± 0.49, which showed signiϐicantly less pain in patients receiving ropivacaine with fentanyl. Total analgesic consumption was also signiϐicantly lower in Group 3 patients (p < 0.001) in comparison to Group 1 and Group 2. In Group 1, the total analgesic (diclofenac) consumption was 149 ± 42 mg; in Group 2, 97 ± 47 mg; and in Group 3, 84 ± 25 mg. Conclusion Intraperitoneal instillation of ropivacaine with fentanyl reduces not only the intensity of visceral, parietal and shoulder pain but also the total rescue analgesic dose consumption.

Evidence‐based postoperative pain management after laparoscopic colorectal surgery

The aim of this systematic review was to evaluate the available literature on the management of pain after laparoscopic colorectal surgery. Randomized studies, published in English between January 1995 and July 2011, assessing analgesic and anaesthetic interventions in adults undergoing laparoscopic colorectal surgery, and reporting pain scores, were retrieved from the Embase and MEDLINE databases. The efficacy and adverse effects of the analgesic techniques was assessed. The recommendations were based on procedure-specific evidence from a systematic review and supplementary transferable evidence from other relevant procedures. Of the 170 randomized studies identified, 12 studies were included. Overall, all approaches including ketorolac, methylprednisolone, intraperitoneal instillation of ropivacaine, intravenous lidocaine infusion, intrathecal morphine and epidural analgesia improved pain relief, reduced opioid requirements and improved bowel function. However, there were significant differences in the study designs and the variables evaluated, precluding quantitative analysis. The L'Abbé plots of the data from the epidural analgesia studies included in this review indicate that the pain scores in the nonepidural groups, although higher than those in the epidural groups, were within an acceptable level (i.e. < 4/10). Infiltration of surgical incisions with local anaesthetic at the end of surgery, systemic steroids, conventional nonsteroidal anti-inflammatory drugs or cyclooxygenase-2-selective inhibitors in combination with paracetamol with opioid used as rescue are recommended. Intravenous lidocaine infusion is recommended, but not as the first line of therapy. However, neuraxial blocks (i.e. epidural analgesia and spinal morphine) are not necessary based on high risk:benefit ratio.

The Effect of Intraperitoneal Ropivacaine on Pain after Laparoscopic Colectomy: A Prospective Randomized Controlled Trial

Although laparoscopic procedures are becoming more common, postoperative pain remains a major factor causing delayed patient recovery. There have been several trials to reduce pain by instilling local anesthetics into the peritoneal cavity, but there has been no study on prolonged (∼300 min) or intensive surgery. We investigated the analgesic effect of intraperitoneal ropivacaine instillation after laparoscopic colectomy. Sixty patients were randomized to three groups. Twenty patients in each group received 50 mL of appropriate solutions after the formation of a pneumoperitoneum. The solution was normal saline (control) in group C and 1 mg/kg of ropivacaine in each of groups I and D. In group D, ropivacaine was sprayed again before the elimination of the pneumoperitoneum. Patients reported their postoperative pain using a subjective visual analogue scale. Fentanyl use for pain relief and frequency of pushing a button (FPB) for a bolus of patient controlled analgesia were evaluated, and scales of recovery rates were obtained. The immediate postoperative pain score was lower in groups I and D than in group C. In groups I and D, FPB measures and fentanyl use were both less than in group C. The time taken to resume a regular diet was shorter in group D than in group C. The intraperitoneal instillation of ropivacaine was effective in reducing postoperative pain and in shortening the recovery course after laparoscopic colectomy. The additional instillation of ropivacaine at the end of the surgery proved even more effective.

Efficacy of Periportal Infiltration and Intraperitoneal Instillation of Ropivacaine After Laparoscopic Surgery in Children

Postoperative pain is less intense after laparoscopic than after open surgery. However, minimally invasive surgery is not a a pain-free procedure. Many trials have been done in adults using intraperitoneal and/or incisional local anesthetic, but similar studies have not yet been reported in the literature in children. The aim of this study was to evaluate the analgesic effect of periportal infiltration and intraperitoneal instillation of ropivacaine in children undergoing laparoscopic surgery. Thirty patients who underwent laparoscopic surgery were randomly allocated to one of three groups. Group A (n = 10) received local infiltration of port sites with 10 mL of ropivacaine. Group B (n = 10) received both an infiltration of port sites with 10 mL of ropivacaine and an intraperitoneal instillation of 10 mL of ropivacaine. Group C did not receive any analgesic treatment. The local anesthetic was always administered at the end of surgery. The degree of postoperative abdominal parietal pain, abdominal visceral pain, and shoulder pain was assessed by using a Wong-Baker pain scale and a Visual Analog Scale (VAS) at 3, 6 12, and 24 hours postoperatively. The following parameters were also evaluated: rescue analgesic treatment, length of hospital stay, and time of return to normal activities. Three hours after operation, patients had low pain scores. Six and 12 hours postoperatively, the abdominal parietal pain was significantly higher (P < 0.0005) in group C than in the other two groups, both treated with an infiltration at the trocar sites; mean intensity of abdominal visceral pain was significantly lower (P < 0.0005) in group B than in groups A and C; the overall incidence of shoulder pain was significantly lower (P < 0.0005) in group B patients than in patients of groups A and C. At 20 hours postoperatively, pain scores were significantly reduced of intensity in all groups. Rescue analgesic treatment was significantly higher in group C, if compared to groups A and B 12 hours after the operation. No statistically significant difference was found in length of hospital stay, but children who received analgesic treatment had a more rapid return to normal activities than untreated patients (P < 0.0005). Our study demonstrates that the combination of local infiltration and intraperitoneal instillation of ropivacaine is more effective for pain relief in children after laparoscopic surgery than the administration of ropivacaine only at the trocar sites.