Combination of pre-emptive port-site and intraoperative intraperitoneal ropivacaine for reduction of postoperative pain: a prospective cohort study

• Published in: European journal of obstetrics & gynecology and reproductive biology 2014-08, Vol.179, p.11-16
• Main Authors: Jiménez Cruz, Jorge, Diebolder, Herbert, Dogan, Askin, Mothes, Anke, Rengsberger, Mathias, Hartmann, Michael, Meissner, Winfried, Runnebaum, Ingo B
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Amides - administration & dosage; Amides - therapeutic use; Anesthetics, Local - administration & dosage; Anesthetics, Local - therapeutic use; Cohort Studies; Female; Gynaecologic laparoscopy; Gynecologic Surgical Procedures - adverse effects; Humans; Intraperitoneal instillation; Laparoscopy - adverse effects; Local anaesthetics; Middle Aged; Obstetrics and Gynecology; Pain; Pain Measurement; Pain, Postoperative - drug therapy; Pain, Postoperative - etiology; Pain, Postoperative - prevention & control; Port-site infiltration; Prospective Studies; Ropivacaine; Treatment Outcome; Young Adult
• ISSN: 0301-2115; 1872-7654
• DOI: 10.1016/j.ejogrb.2014.05.001

Abstract Objective To evaluate the effectiveness of intraoperatively applied local ropivacaine added to standard analgesic therapy in reducing postoperative pain intensity and opioid requirement under routine hospital conditions. Study design In this prospective controlled cohort study, 303 consecutive patients receiving a gynaecological laparoscopic intervention at the Jena University Hospital were included. The study cohort ( n = 168) received, in addition to standard pain management, a port-site (PS) infiltration with ropivacaine prior to incision and intraperitoneal (IP) instillation at the end of surgery. On the first postoperative day patients answered a validated questionnaire, and requirement of rescue analgesics was assessed. Results Pain intensity was assessed on an 11-point numeric rating scale (NRS) from 0 = no pain to 10 = most severe pain. Reported pain intensity for movement-related pain was significantly lower ( p = .001) in the study group compared with the control group (4.4 (SD 2.4) vs. 5.3 (SD 2.2) respectively). Minimal pain intensity after operation was also significantly lower in the study cohort (2.6 (SD 1.7) vs. 2.1 (SD 1.8), ( p = .007)). Significantly fewer patients required rescue opioids for analgesia in the ropivacaine cohort ( p = .001). The requested dose of rescue opioid (piritramide) in this cohort was also lower ( p = .035) with 6.5 mg (SD 4.9) vs. 8.7 mg (SD 6.6), and demanded later ( p = .001) with 4.3 h after surgery vs. 3.1 h. Patients in the study cohort experienced less nausea ( p = .046). Higher satisfaction scores with pain management were reported in the ropivacaine group 12.7 (SD 2.5) vs. 11.6 (SD 2.8) ( p < .001) (16-point NRS with 0 = not at all, 15 = completely satisfied). Conclusion Addition of pre-emptive port-site plus intraperitoneal ropivacaine to standard postoperative analgesic therapy reduced postoperative pain intensity and opioid consumption in gynaecological laparoscopy.