Ropivacaine Infiltration Research Articles

A prospective comparison of WALANT technique and general anesthesia in forefoot surgery

IntroductionWide Awake Local Anesthesia No Tourniquet (WALANT) technique has been widely used in hand surgery, but there are few prospective data on its use in forefoot surgery. HypothesisThe WALANT technique reduces pain compared to general anesthesia for bone surgery on the first ray of forefoot. MethodsThis was a prospective, longitudinal, comparative, non-randomized cohort study in adult patients undergoing bone surgery on the first ray of forefoot. The primary objective was the level of pain (0–10 visual analogic scale) 4 h after the procedure with WALANT technique versus general anesthesia supplemented by ropivacaine infiltration. ResultsA total 37 patients were analyzed in the WALANT group and 24 in the general anesthesia group (women, 90.2%; mean age, 51.3 years; hallux valgus, 85.2%; first metatarsal osteotomy, 80.3%). After generalized linear regression adjusted on a priori defined factors, there was no statistically difference for pain ≤3 at 4 h in WALANT vs. general anesthesia (odds-ratio 1.66; 95% CI, 0.17–20.49; p = 0.2548). At 24 h, pain level was also comparable in the two groups. Time spent in operating room was significantly shorter with WALANT (40.8 vs. 49.7 min; p = 0.0001). Mean length of stay in the recovery room was also significantly shorter with WALANT (4.4 vs. 75.6 min; p < 0.0001). Anxiety before/after surgery, uptake of analgesic/anti-inflammatory drugs and quality of life were comparable in the two anesthesia groups. ConclusionPostoperative pain with WALANT technique or general anesthesia was comparable. Time spent in the operating room and in recovery room was significantly shorter with WALANT technique. Level of evidenceIII; prospective non-randomized comparative study.

Analgesic Efficacy of Ropivacaine Infiltration on Early Post-Tonsillectomy Pain in Pediatrics.

To assess the analgesic efficacy of ropivacaine infiltration in the tonsillar fossa among pediatric patients undergoing tonsillectomy. PubMed, Scopus, Web of Science, and CENTRAL. Eligible randomized controlled trials (RCTs) were assessed for bias using Cochrane's risk of bias tool (version 2). Our primary outcome was postoperative pain within 24 h, and secondary outcomes included operative time, intraoperative blood loss, time to first analgesia, bleeding, and nausea/vomiting. Data were pooled as mean difference, standardized mean difference, and risk ratio with a 95% confidence interval. Our review included 11 RCTs, with a total of 712 patients. The quality of studies varied and included low risk (n = 8 RCTs), some concerns (n = 2 RCTs), and high risk (n = 1 RCT) of bias. The primary endpoint of postoperative pain across all time points was significantly reduced in the ropivacaine group compared with the placebo group. Trial sequential analysis (TSA) of the postoperative pain depicted conclusive evidence and unnecessity for further RCTs. The mean operative time was significantly reduced in the ropivacaine group compared with the placebo group. However, there was no significant difference between both groups regarding additional clinical (i.e., mean intraoperative blood loss and mean time to first analgesia) and safety (i.e., rates of bleeding and nausea/vomiting) outcomes. This systematic review and meta-analysis demonstrated the safety and postoperative analgesic efficacy of ropivacaine versus placebo among pediatric patients undergoing tonsillectomy. There was no significant difference between both groups regarding intraoperative blood loss, time to first analgesia, and rate of postoperative bleeding. 1 Laryngoscope, 134:3018-3029, 2024.

To assess the analgesic efficacy of adjuvant magnesium sulfate added with ropivacaine over ropivacaine alone as a continuous infiltration in total abdominal hysterectomy wound: A randomized controlled trial.

Magnesium sulfate (MgSO4) has been demonstrated to have analgesic property in various clinical settings. This study explores if addition of MgSO4 to ropivacaine increases its analgesic efficacy when infiltrated continuously in the postsurgical wound following total abdominal hysterectomy. This randomized controlled trial was conducted at a tertiary care referral hospital in New Delhi, India. Fifty-two patients were randomized into two groups to receive the intervention of which 48 were able to complete the study. The first group (n = 26) received 0.25% ropivacaine infiltration and the second group (n = 26) received 0.25% ropivacaine with 5% MgSO4 at the incision site for 48 h postoperatively. Primary objective was to compare the total postoperative opioid (morphine) consumption by the study participants in both the groups and the secondary objectives were pain scores at rest and at movement, patient satisfaction score, and wound quality of life on the 7th postoperative day among the two groups. Both the groups were comparable in their demographic characteristics. The median morphine consumed at 48 h postoperatively was 16.5 [0-77] mg in the ropivacaine group and 13[1-45] mg in the ropivacaine with MgSO4 group and the difference was statistically insignificant (P = 0.788). There was no statistical difference between the groups with respect to the pain scores, patient satisfaction, or wound quality of life at 7 days. The addition of MgSO4 to ropivacaine does not confer any additional postoperative analgesic benefits over ropivacaine alone in continuous wound infiltration following total abdominal hysterectomy.

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.

The effect of ropivacaine infiltration on the expression of Vascular Endothelial Growth Factor (VEGF) on skin defect: experimental study on Wistar rats

Link of Video Abstract: https://youtu.be/jNHUCHSk70Y Background: The main problems of postoperative patients are pain and wound. The healing phases consist of hemostasis, inflammation, proliferation, and remodeling. Postoperative pain causes surgical stress, which disrupts wound healing by delaying the transition from the inflammatory phase to the proliferative phase. Ropivacaine infiltration is expected to reduce surgical stress. One of the parameters that can be used to assess wound healing is Vascular Endothelial Growth Factor (VEGF) expression. This study aims to evaluate the infiltration effect of ropivacaine on the expression of VEGF in post-surgical skin defects in Wistar rats. Methods: This study was an experimental study using 32 Wistar rats (Rattus norvegicus), which were randomly divided into 2 groups. With a 2 cm full-thickness wound incision, the ropivacaine group was given 0.2% 1 ml of ropivacaine infiltration, while the control group was given NaCl infiltration. 0.9% 1 ml. Tissue samples were taken on day 5 to calculate VEGF expression through immunohistochemical examination. Data were analyzed using SPSS versin 23.0 for Windows. Results: Assessment of the weight of the Wistar rats did not show a significant difference (p = 0.788). Using the IRS (Immunoreactivity Score), there was a significant difference in VEGF expression (p = 0.033) between the two groups. There were significant differences in the degree of VEGF cells between the two groups (p = 0.001). Analysis of the relationship between treatment and degree of VEGF cells showed a significant relationship (p = 0.005). Conclusion: Infiltration of ropivacaine had effects on the expression of VEGF in postsurgical skin defects of Wistar rats

Efficacy of Hematoma Block after Intramedullary Rod Fixation of Femoral Shaft Fractures: A Prospective, Double-Blinded, Randomized Controlled Trial.

To evaluate the efficacy of an intraoperative, post-fixation fracture hematoma block on postoperative pain control and opioid consumption in patients with acute femoral shaft fractures. Prospective, double-blinded, randomized controlled trial. Academic Level I Trauma Center.Patients/Participants: 82 consecutive patients with isolated femoral shaft fractures (OTA/AO 32) underwent intramedullary rod fixation. Patients were randomized to receive an intraoperative, post-fixation fracture hematoma injection containing either 20 mL of normal saline or 0.5% ropivacaine in addition to a standardized multimodal pain regimen that included opioids. Visual analog scale (VAS) pain scores and opioid consumption. The treatment group demonstrated significantly lower VAS pain scores than the control group in the first 24-hour postoperative period (5.0 vs 6.7, p=0.004), 0-8 hours (5.4 vs 7.0, p=0.013), 8-16 hours (4.9 vs 6.6, p=0.018), and 16-24 hours (4.7 vs 6.6, p=0.010) postoperatively. In addition, the opioid consumption (morphine milligram equivalents) was significantly lower in the treatment group compared to the control group over the first 24-hour postoperative period (43.6 vs 65.9, p=0.008). No adverse effects were observed secondary to the saline or ropivacaine infiltration. Infiltrating the fracture hematoma with ropivacaine in adult femoral shaft fractures reduced postoperative pain and opioid consumption compared with saline control. This intervention presents a useful adjunct to multimodal analgesia to improve postoperative care in orthopaedic trauma patients. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Evaluation of role of peri portal infiltration of ropivacaine in post laparoscopic cholecystectomy pain management: a randomized controlled double-blind study

Background: Laparoscopic cholecystectomy is considered as the treatment of choice for symptomatic cholelithiasis. The present study was conducted to assess the role of peri-portal infiltration of ropivacaine in post laparoscopic cholecystectomy pain management. Methods: A total of 100 eligible cases undergoing laparoscopic cholecystectomy were randomly allocated in two groups: group A (received infiltration of total 20 ml of 0.5% ropivacaine, 5 ml in each port site after removal of trocar, and group B (received placebo i.e., 20 ml normal saline). Postoperative pain was assessed using Wong Baker facial pain scale at 6, 12 and 18 hours and use of rescue analgesics were noted. Results: Group I comprised of 27 males and 23 females and group II had 25 males and 25 females. The mean heart rate in group I was 85.4 and in group II was 86.2. Respiratory rate was 14.2 cycles/minute in group I and 15.2 cycles/minute in group II. The mean blood pressure was 134.2/74.6 mmHg in group I and 136.4/75.2 mmHg in group II and oxygen saturation was 99.2% in group I and in group II was 99.5%. The mean VAS scores were significantly lower in group A cases as compared to group B, throughout the study follow up (p&lt;0.01). 70% in group A and 90% in group B required 1 dose and 10% in group II required 2 doses. Duration of rescue analgesia was 21.49 minutes in group A and 17.3 minutes in group B. Conclusions: Peri-portal infiltration of ropivacaine is effective in reducing post laparoscopic cholecystectomy pain. Mean duration of analgesia was significantly more and requirement of rescue analgesics were significantly less in cases managed by peri-portal infiltration of ropivacaine as compared to control group (using NSAIDs).

Efficacy of Incisional Ropivacaine Infiltration by Presternal Multi-Orifice Catheter for Post-sternotomy Pain Relief in Pediatric Patients Undergoing Cardiac Surgery: A Prospective, Randomized, Controlled Study

To evaluate the efficacy of incisional ropivacaine infiltration by presternal multi-orifice catheter to manage poststernotomy pain in pediatric cardiac surgery. A prospective, randomized, and double-blind comparative study. At a single-institution tertiary referral cardiac center. The study comprised 200 children undergoing cardiac surgeries through a midline sternotomy. Children were allocated randomly to 1 of 3 groups. Group A (n=65) and group B (n=64) received 0.375% ropivacaine infusion and intermittent bolus, respectively, by presternal multi-orifice catheter, whereas Group C (n=64) did not receive any local anesthetic (LA) drug. Postoperatively, intravenous paracetamol was used for multimodal analgesia, and fentanyl was given as rescue analgesia, respectively. Pain was assessed by a Modified Objective Pain Score (MOPS) for 48 hours postextubation. Group B had significantly lower early MOPS at the first hour, but in the later period, the mean MOPS was lower in group A. The requirement of the first rescue analgesia was 3 ± 1.51, 6.1 ± 2.26, and 2.6 ± 0.87 hours for groups A (n=60), B (n=60), and C (n=60), respectively. The 48-hour fentanyl consumption was significantly lower (p < 0.001) in group A (0.5 ± 0.68 µg/kg) and group B (0.7 ± 0.86 µg/kg) than the control group (3.4 ± 0.68 µg/kg). The length of intensive care unit stay was lower (p < 0.001) in groups A and B than in group C; however, the length of hospital stay was comparable (p=0.07). LA bolus and infusion through presternal multi-orifice catheter provided effective analgesia postoperatively. However, the bolus was more efficacious in the early phase but equivalent in later periods. Therefore, bolus and LA infusion can be used for steady poststernotomy pain relief in children undergoing cardiac surgeries.

A comparative evaluation of intraperitoneal instillation and periportal infiltration of 0.375% ropivacaine with dexmedetomidine and nalbuphine as adjuvants for post-operative analgesia in laparoscopic cholecystectomy

Background: Intraperitoneal instillation (IPI) of local anesthetic agents into peritoneal cavity has proved to be an effective method of post-operative analgesia in laparoscopic cholecystectomy (LC). The addition of adjuvants such as narcotics or α2-agonists has been proposed to prolong the duration of post-operative analgesia. Aims and Objectives: This study aimed to compare post-operative analgesia of IPI and periportal infiltration of ropivacaine plus dexmedetomidine with ropivacaine plus nalbuphine in patients undergoing LC. Materials and Methods: This was a comparative, prospective, randomized controlled double-blind study conducted on total of 100 patients (American Society of Anesthesiologists class I and II) planned for LC who were randomly divided into two groups of 50 patients: Group Ropivacaine+Dexmedetomidine (RD) received IPI and periportal infiltration of 150 mg of ropivacaine (0.375%) and dexmedetomidine (1 μg/kg) diluted with normal saline to 40 mL and Group Ropivacaine+Nalbuphine (RN) received 150 mg of ropivacaine (0.375%) and 10 mg nalbuphine diluted with normal saline to 40 mL. Post-operative pain was assessed by Visual Analogue Score, time to first request of analgesia, and total amount of rescue analgesics given in 24 h and side effects were noted. Data were analyzed by Student’s independent t-test and Chi-square test using SPSS version 20.0. Results: Overall Visual Analog Scale scores (1.38±0.78 vs. 2.59±1.15), time to first request of analgesia (7.3±3.74 vs. 4.2±2.71), and total analgesic consumption (82.4±15.34 vs. 158.5±16.19) were significantly lower in the RD group compared to the RN group. Among post-operative adverse events, the incidence of post-operative nausea and vomiting was significantly higher in the RN group. Conclusion: The addition of dexmedetomidine appears to be superior to nalbuphine in terms of prolonged post-operative analgesia, lesser requirement of rescue analgesia, and less complications.

A COMPARISON OF POST-OPERATIVE PAIN RELIEF AFTER ELECTIVE LSCS WITH LOCAL AND INTRAPERITONEAL ROPIVACAINE INSTILLATION AGAINST LOCAL ROPIVACAINE INFILTRATION ALONE

Objectives: For an anesthesiologist, the post-operative phase is just as crucial as the pre-operative and intraoperative periods. Whether a surgery is performed under regional or general anesthesia, the goal should always be to provide patients with a pain-free and comfortable recovery. Spinal anesthesia is frequently used during caesarean sections, but its effects only last for a few hours. As a result, various multidisciplinary analgesia strategies with few side effects have been attempted for postpartum patients to relieve pain because they may also be harmful to the newborn baby’s health. It has already been proven; injecting ropivacaine is a far safer alternative to injecting bupivacaine. We compared local infiltration of injectable ropivacaine alone to both intraperitoneal instillation and local infiltration for post-operative analgesia in individuals who had cesarean surgery. In the present study, intraperitoneal instillation and local infiltration of ropivacaine 0.5% were compared to local infiltration of ropivacaine 0.5% alone for the management of post-operative pain following elective cesarean section under spinal anesthesia. Methods: Pregnant women in ASA Grades I and II who were having a planned caesarean section under spinal anesthesia were divided into two groups at random (R1 and R2 group, each have 30 patients). Patients in Group R1 received a 15 mL injection of 0.5% ropivacaine at the incision site. Patients in Group R2 had intraperitoneal injections of 0.5% ropivacaine in 5 mL before to peritoneal closure and local infiltrations of 10 mL ropivacaine at the site of the incision before skin closure. The duration of the analgesia was calculated by timing the start of the sensory block to a point at which rescue analgesia was sought throughout the post-operative period. Pain intensity was measured using the visual analog scale (VAS). Data on the hemodynamics and side effects of the patients were also gathered. Results: Group R2 analgesia lasted much longer than that of Group R1 (p&lt;0.05). The mean (±SD) analgesic duration in the R1 and R2 groups was 147.17±4.67 and 170.33±3.69 min, respectively. The mean (SD) VAS scores for Group R1 and Group R2 at the moment of the first analgesic demand were 36.7±5.14 and 32.6±6.52, respectively. Conclusion: When combined with intraperitoneal instillation during spinal anesthesia, inj. ropivacaine 0.5% local infiltration enhances post-operative analgesia in cesarean section procedures.

To Study the Effect of Pre-incisional Infiltration of Ropivacaine for Post-tonsillectomy Pain Relief

To Study the Effect of Pre-incisional Infiltration of Ropivacaine for Post-tonsillectomy Pain Relief

Peritonsillar Infiltration of Ropivacaine and Pain Control in Immediate Postoperative Period Following Tonsillectomy Surgery in Adult Patients

Introduction: To study about the efficacy of Peritonsillar infiltration of Ropivacaine and pain control in immediate postoperative period following tonsillectomy surgery in adult patients. Methods: 80 patients were included in the study of age 18 to 50 years. After informed consent, patients were divided into two groups. In Group R 0.5%Ropivacaine with 1:100000 Adrenaline and in Group C 0.9%normal saline with 1:100000 Adrenaline was injected into the tonsillar fossa following tonsillectomy. Surgery duration, blood loss, time to demand for 1st analgesia, analgesic consumption in 24 hours, and VAS score in 1hr, 2hr, 4hr, 6hr, 12hr, 24hr were noted. Results: We observed significant pain control during first 4 post-operative hours with Value of &lt;0.01, &lt;0.01 and 0.019 respectively in first, second and fourth post-operative score. We also observed significant difference in the time for first analgesia request in two groups with the study group requesting for first analgesic at 518±175 postoperative minutes and control group at 132±47.95 postoperative minutes (P value &lt;0.01). Total analgesia requirement was 61±22.48 in the study group and 102±27.84 in control group (P value &lt; 0.01). Conclusions: It is concluded that intraoperative Peritonsillar infiltration of Ropivacaine causes analgesia in the immediate postoperative hours with the decrease in the requirement of analgesia in the first 24 postoperative hours. It is therefore recommended to use it in adult patient undergoing Tonsillectomy.

Effect of balanced opioid-free anaesthesia on postoperative nausea and vomiting after video-assisted thoracoscopic lung resection: protocol for a randomised controlled trial

IntroductionOpioid-free anaesthesia (OFA) may reduce opioid-related side effects such as postoperative nausea and vomiting (PONV) and hyperalgesia. This study aims to investigate the effects of balanced OFA on PONV and...

Continuous Ropivacaine Peroneal Nerve Infiltration for Fibula Free Flap in Cervicofacial Cancer Surgery: A Randomized Controlled Study.

Introduction: Pain after cervicofacial cancer surgery with free flap reconstruction is both underestimated and undertreated. There is a rational for regional anesthesia at the flap harvest site, but few studies describe it. We assessed the influence of common peroneal nerve infiltration on pain and opioid consumption in patients having oropharyngeal cancer surgery with fibular free flap mandibular reconstruction. Methods: After institutional review board (IRB) approval and written informed consent, fifty-six patients were randomly allocated to perineural catheter with ropivacaine infiltration (ROPI) or systemic analgesia (CONTROL). In the ROPI group, an epidural catheter was placed by the surgeon before closure, and ropivacaine 0.2% 15 mL, followed by 4 mL/h during 48 h, was administered. The primary outcomes were pain scores and morphine consumption during the 48 h postoperative period. We also measured ropivacaine concentration at the end of infusion. Finally, we retrospectively assessed long-term pain up to 10 years using electronic medical charts. Results: Perineural infiltration of ropivacaine significantly reduced pain scores at the harvest site only at day 1, and did not influence overall postoperative opioid consumption. Ropivacaine assay showed a potentially toxic concentration in 50% of patients. Chronic pain was detected at the harvest site in only one patient (ROPI group), and was located in the cervical area in the case of disease progression. Discussion: Although the catheter was visually positioned by the surgeon, continuous ropivacaine infiltration of the common peroneal nerve did not significantly reduce postoperative pain, but induced a blood concentration close to the toxic threshold at day 2. Further studies considering other infiltration locations or other dosing schemes should be tested in this context, both to improve efficacy and reduce potential toxicity.

A Comparative Study of Intravenous Dexmedetomidine with Local Infiltration of Ropivacaine in Attenuation of Stress Response to Skull Pin Insertion in Craniotomies.

Objective Skull pin insertion in patients undergoing craniotomies elicits hemodynamic and neuroendocrine stress response that may be deleterious to the patient. Various drugs and techniques have been documented in literature to abate this stress response. Against this background, we aimed to compare the efficacy of intravenous dexmedetomidine and local infiltration of ropivacaine for attenuation of stress response to pin insertion in craniotomies. Methods Eighty-eight adult patients undergoing craniotomy under general anesthesia from March 2019 to April 2020 requiring application of head holder were randomized into two equal groups. After intubation, 0.75 µg kg -1 of dexmedetomidine over 10 minutes through infusion was given in group D, while local infiltration at pin sites was done with 0.5% ropivacaine, 2 mL at each site in group R. Hemodynamic parameters and levels of serum cortisol, prolactin, and blood glucose were measured before and after pin insertion. Unpaired t -test for continuous variables and Mann-Whitney U test was used for nonnormally distributed variables. Results Heart rate was statistically similar between the two groups at all the observed time points. The difference in mean arterial pressure values between the two groups was found to be statistically significant only from 10 to 20 minutes after pin insertion being statistically similar at rest of the time points. Levels of serum glucose, cortisol, and prolactin values 30 minutes after pin insertion were statistically similar between both groups. Conclusion We concluded that both interventions are equally efficacious in attenuation of hemodynamic and stress response to head holder application in patients undergoing craniotomies.

Ropivacaine perineal infiltration for postpartum pain management in episiotomy repair: a double-blind, randomised, placebo-controlled trial.

To investigate whether perineal infiltration of ropivacaine after episiotomy would decrease the incidence of postpartum pain compared with placebo. Two-centre, double-blind, randomised, controlled trial. Two French maternity units, October 2017 to April 2020. 272 women undergoing epidural analgesia with vaginal singleton delivery and mediolateral episiotomy at term (≥37 weeks) were randomly allocated perineal infiltration of ropivacaine (n= 135) or placebo (n= 137) in a 1:1 ratio before episiotomy repair. Patients were followed at short term (12, 24, 48 h), mid-term (day 7) and long-term (3 and 6months). The primary outcome was the rate of perineal pain, defined by a Numerical Pain Rating Scale (NPRS) exceeding 3/10, in the mid-term (day 7) postpartum period. Secondary outcomes were perineal pain (NPRS) and analgesic intake, quality of life (SF-36), postpartum depression (EPDS), pain neuropathic component (DN4) and sexual health (FSFI). Perineal pain occurred to an equal extent in the ropivacaine and placebo groups at day 7 (34.2% versus 30.4%, odds ratio 1.1, 95% confidence interval 0.7-1.8, p= 0.63). Similar results were recorded in the short and long term. High rates of dyspareunia and postpartum depression were documented in both groups. No differences were highlighted between the groups in terms of analgesic intake, adverse events, pain neuropathic component and postpartum quality of life. This study did not demonstrate any benefit of ropivacaine infiltration over placebo.

Ultrasound-guided Transversus Abdominis Plane Block is Effective as Laparoscopic Trocar site infiltration in Postoperative Pain Management in Patients Undergoing Adrenal Surgery.

Pain management in patients undergoing laparoscopy is still a matter of debate as several techniques have been proposed to reduce postoperative analgesic consumption and improve recovery. Among these, transversus abdominis plane (TAP) block is considered as safe, effective, and easy to perform under ultrasound guidance; even so, recently laparoscopically guided trocar site anesthetic infiltration has been proposed as a "surgeon-dependent alternative to TAP block." The aim of this evaluation is to compare these analgesic techniques in the setting of laparoscopic adrenalectomy. This is a retrospective evaluation of a prospectively maintained database. Patients were divided into two groups: Group A patients received laparoscopic-assisted trocar site infiltration of ropivacaine; Group B patients received bilateral ultrasound-guided TAP block with ropivacaine. All patients received 24h infusion of 20mg morphine postoperatively; pain was checked at 6, 24 and 48h after surgery. A rescue analgesia was given if numerical rating scale (NRS) score was > 4 or on patient request. One hundred and three patients were enrolled in the evaluation (57 in group A and 46 in group B). There were no differences in operative time, complications and postoperative stay, and no complications related to trocar site infiltration. There were no differences in NRS at 6, 24, and 48hours as well as in patients requiring further analgesic administration. Laparoscopic-guided trocar site ropivacaine infiltration has similar pain outcomes compared to ultrasound-guided TAP block in the management of postoperative pain in patients undergoing laparoscopic adrenalectomy. Since there is no difference among these techniques, the decision can be based on surgeon or anesthesiologist preference.

Subfascial infiltration of 0.5% ropivacaine, but not 0.25% ropivacaine, exacerbates damage and inflammation in surgically incised abdominal muscles of rats

Ropivacaine-induced myotoxicity in surgically incised muscles has not been fully investigated. We evaluated the effects of infiltration anesthesia with ropivacaine on damage, inflammation and regeneration in the incised muscles of rats undergoing laparotomy. Ropivacaine or saline was infiltrated below the muscle fascia over the incised muscles. Pain-related behaviors and histological muscle damage were assessed. Macrophage infiltration at days 2 and 5 and proliferation of satellite cells at day 5 were detected by CD68 and MyoD immunostaining, respectively. Pain-related behaviors were inhibited by 0.25% and 0.5% of ropivacaine for 2 h after surgery. Single infiltration of 0.5% ropivacaine did not induce injury in intact muscles without incision, but single and repeated infiltration of 0.5% ropivacaine significantly augmented laparotomy-induced muscle injury and increased the numbers of CD68-positve macrophages and MyoD-positive cells compared to those in rats with infiltration of saline or 0.25% ropivacaine. In contrast, there were no significant differences in them between rats with saline infusion and rats with 0.25% ropivacaine infiltration. In conclusion, single or repeated subfascial infiltration of 0.25% ropivacaine can be used without exacerbating the damage and inflammation in surgically incised muscles, but the use of 0.5% ropivacaine may be a concern because of potentially increased muscle damage.

Effect ropivacaine infiltration in incisional wound on caspase-3 expression and apoptosis squamous cells wound healing

Wound healing and tissue regeneration consist of molecular and cellular process that occur right after wound formation. The intrinsic pathway of apoptosis, apoptosome produced to initiate the formation of Caspase 3 important role in apoptosis. One of the methods that accelerates wound healing process by eliminating pain by infiltration of local anesthesia. This study aims to determine the effect of ropivacaine infiltration as local anaesthesia in the expression of Caspase 3 and apoptosis. This study is an experimental study with randomized post-test only control group design. The samples of this study were 24 wistar rats. The rats divided into four groups then incised, either followed by 1 ml ropivacaine 0.2% infiltration or left as is. Excisional biopsy procedures were done on third and seventh day. Then analyzed by SPSS. Expression of Caspase 3 on squamous cell epithel of control and intervention group was found statistically different on day 3 (p=0.024) and day 7 (p=0.041). Number of apoptosis on squamous cell epithel of control and intervention was found statistically different on day 7 (p=0.031) but not on day 7 (p=0.414). Ropivacaine infiltration on incision wound decreased the expression of Caspase 3 on day 3 and 7; and apoptosis on day 7.

A Randomized Controlled Trial of Lidocaine versus Ropivacaine for Pain Relief after Episiotomy

Introduction: Episiotomy is the most common surgical procedure for parturient. Analgesia after episiotomy has received less attention, though the postepisiotomy pain may hamper the day-to-day activities such as sitting, sleeping, urinating, and walking of the parturient. It is desirable to reduce the postepisiotomy pain as early as possible. Therefore, we planned to carry out a randomized controlled trial to compare the safety and efficacy of lidocaine versus ropivacaine perineal infiltration for pain relief after episiotomy. Materials and Methods: The prospective randomized controlled trial was conducted in the Department of Obstetrics and Gynaecology of R. G. Kar Medical College and Hospital, Kolkata. One hundred women were enrolled and randomized into the two groups: Lidocaine infiltration group and ropivacaine infiltration group. Primary objective was to evaluate the efficacy of postepisiotomy pain control by the visual analog scale (VAS) score at 24 h after the episiotomy. Secondary objectives were to evaluate the efficacy of postepisiotomy pain control by VAS score during suturing, at 2 h and 48 h or any adverse effects and maternal satisfaction at 48 h. Results: The postepisiotomy pain relief at 2 h and 24 h was significantly lower in ropivacaine in comparison to lidocaine infiltration. Mean VAS Score 24 h after suturing in lidocaine group was 6.38, and in ropivacaine group, it was 5.64. Maternal pain perception at the time of suturing and at 48 h was also less in ropivacaine than in lidocaine infiltration. Mothers were more satisfied with ropivacaine drug. Conclusion: The present study showed that there was definite improvement of postepisiotomy pain relief at 2 h and 24 h in ropivacaine local infiltration of the episiotomy wound in comparison to lidocaine infiltration and mothers were more satisfied with ropivacaine use.