Combined field block and i.p. instillation of ropivacaine for pain management after laparoscopic sterilization

Department of Anaesthesiology, H:S Hvidovre University Hospital, Denmark.
BJA British Journal of Anaesthesia (Impact Factor: 4.85). 04/1999; 82(4):586-90. DOI: 10.1093/bja/82.4.586
Source: PubMed


We have studied the effect of ropivacaine for combined port site and mesosalpinx infiltration, and peritoneal instillation
on pain, nausea and vomiting after laparoscopic sterilization, in a double-blind, placebo-controlled study in 80 patients.
The total dose of ropivacaine was 285 mg. All patients received intra- and postoperative NSAID in fixed doses. Abdominal and
shoulder pain, nausea and vomiting were recorded during the first 8 h after operation and in a diary for 3 days. In the ropivacaine
group, abdominal pain scores were lower during the first 4 h (P < 0.00001), additional use of morphine was less (P < 0.001)
and fewer patients had nausea or vomiting during the first 72 h (five vs 14; P < 0.05). There were no signs of local anaesthetic

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Available from: Håkan Reventlid, Jan 21, 2014
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    • "In order to reduce postoperative pain related to TL by laparoscopy many therapeutic schemes have been suggested. Ropivacaine use in laparoscopic trocar ports and in mesosalpinx, associated with anti-inflammatory drugs, reduced postoperative pain in TL with the Filshie clips [2]. Similarly, bupivacaine alone [3] or associated with meperidine [4], as well as associated with topical lidocaine [5] on the Fallopian tube in TL with the Filshie clips, reduced postoperative pain compared to placebo. "

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    ABSTRACT: Due to the well-known advantages of minimal invasive surgery, the majority of procedures for benign gynaecological diseases are performed by laparoscopy. Although laparoscopic surgery results in improved patient satisfaction, a considerable portion of patients have complaints of post-operative shoulder pain. This review presents an overview of the currently evaluated techniques to reduce shoulder pain after laparoscopic surgery for benign gynaecological disease. According to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, a systematic review was conducted using Medline, Embase and Cochrane databases. Randomised clinical trials reporting techniques to reduce shoulder pain after laparoscopic gynaecologic procedures for benign diseases were included. Eighty-eight articles were screened for inclusion. A total of 15 articles were included in the final review. The following studies described the techniques used to reduce shoulder pain: six studies evaluated the effect of local anaesthetics, three studies evaluated the effect of pulmonary recruitment manoeuvre and three studies evaluated the effect of intraperitoneal drainage. The remaining three studies evaluated the effect of saline installation, minilaparoscopy and gasless laparoscopy by using the Laprolift®. Overall, the pulmonary recruitment manoeuvre and intraperitoneal drainage were found to reduce the incidence and severity of shoulder pain (SP). Based on the current evidence, safety and possibility to implement the technique in daily practice, pulmonary recruitment manoeuvre can be recommended to reduce both the incidence and severity of SP.
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    ABSTRACT: We tested the hypothesis that local anesthetics instilled at the end of laparoscopic gynecologic procedures are able to prevent postoperative pain at wake-up and during the first 24 h. A total of 180 patients were randomly assigned into three groups to receive an intraperitoneal instillation of 20 mL of either bupivacaine 0.5% (Group B), ropivacaine 0.75% (Group R) or saline (Group S) at the end of surgery. All patients received analgesia with acetaminophen and ketoprofen IV infusions. Pain was assessed by using a 0-10 graded numerical scale (NS) every 5 min in the postanesthesia care unit and IV morphine was administered if NS was >4. Assessment of pain was continued every 4 h on the ward, and subcutaneous morphine was injected if needed to keep the NS score < 4. Postoperative nausea and vomiting (PONV) was rated on a 4-point scale. The morphine consumption at wake-up and over the first 24 h was significantly lower (P < 0.05) in Group B (mean, 0.92 mg at wake-up; 3.08 mg over 24 h) and in Group R (mean, 0.25 mg at wake-up; 0.69 mg over 24 h), than in Group S (mean, 4.18 mg at wake-up; 12.93 mg over 24 h). The morphine-sparing effect of ropivacaine was significantly greater than that of bupivacaine. Both local anesthetics were effective in the prevention of PONV. We concluded that local anesthetics should be instilled in all gynecologic patients at the end of all laparoscopic procedures. Implications: Local anesthetic instillation (ropivacaine rather than bupivacaine) at the end of laparoscopy prevents postoperative pain and dramatically decreases the need for morphine. This technique, compared with placebo, is safe, improves patient comfort, shortens the stay in the postoperative care unit and decreases nursing care in the ward.
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