Peritrocal and Intraperitoneal Ropivacaine for Laparoscopic Cholecystectomy: A Prospective, Randomized, Double-Blind Controlled Trial

• Published in: The Journal of surgical research 2012-06, Vol.175 (2), p.251-258
• Main Authors: Cha, Su Man, M.D, Kang, Hyun, M.D, Baek, Chong Wha, M.D, Jung, Yong Hun, M.D, Koo, Gill Hoi, M.D, Kim, Beom Gyu, M.D, Choi, Yoo Shin, M.D, Cha, Seong Jae, M.D, Cha, Young Joo, M.D
• Format: Article
• Language: English
• Subjects: Administration, Topical; Adult; Aged; Amides - administration & dosage; Amides - therapeutic use; Anesthetics, Intravenous; Anesthetics, Local - administration & dosage; Anesthetics, Local - therapeutic use; Cholecystectomy, Laparoscopic - adverse effects; Double-Blind Method; Female; Fentanyl - administration & dosage; Fentanyl - therapeutic use; Humans; Infusions, Parenteral; Male; Middle Aged; Pain Measurement; Pain, Postoperative - etiology; Pain, Postoperative - prevention & control; Prospective Studies; Shoulder Pain - etiology; Shoulder Pain - prevention & control; Surgery; Treatment Outcome; Visceral Pain - etiology; Visceral Pain - prevention & control
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2011.04.033

Background The goal of this study was to evaluate the effect of peritrocal, intraperitoneal, or combined peritrocal-intraperitoneal ropivacaine on the parietal, visceral, and shoulder tip pain after laparoscopic cholecystectomy. Methods Eighty patients were randomly assigned to four groups. Group A received peritrocal and intraperitoneal saline. Group B received peritrocal saline and intraperitoneal ropivacaine. Group C received peritrocal ropivacaine and intraperitoneal saline. Group D received peritrocal and intraperitoneal ropivacaine. The parietal, visceral, and shoulder tip pain were assessed at 2, 4, 8, 12, 24, and 48 h postoperatively using a visual analog scale (VAS). The frequency of the patient pushing the button of the PCA and fentanyl use were also recorded. Results In visceral pain, significantly lower VAS scores were observed in Group B from 2 to 4 h and in Group D from 2 to 8 h. In parietal pain, significantly lower VAS scores were observed in Group C from 4 to 24 h and in Group D from 2 to 12 h. In shoulder tip pain, significantly lower VAS scores were observed in Group B from 4 to 48 h and in Group D from 2 to 12 h. The fentanyl use and the frequency to push the button of the PCA were the highest in Group A and the lowest in Group D at every time point. Conclusions We conclude that peritrocal infiltration of ropivacaine significantly decreases parietal pain and intraperitoneal instillation of ropivacaine significantly decreases the visceral and shoulder tip pain. Their effects are additive with respect to the total pain.