Postoperative Analgesia after Laparoscopic Ovarian Cyst Resection: Double-blind Multicenter Randomized Control Trial Comparing Intraperitoneal Nebulization and Peritoneal Instillation of Ropivacaine.

Abstract

STUDY OBJECTIVE:

To compare the effects of local anesthetic intraperitoneal nebulization with intraperitoneal instillation during laparoscopic ovarian cystectomy on postoperative morphine consumption and pain.

DESIGN:

Multicenter, randomized, case-control trial.

DESIGN CLASSIFICATION:

Canadian Task Force Classification I.

SETTING:

University hospitals in Italy.

PATIENTS:

One hundred forty patients scheduled for laparoscopic ovarian cystectomy.

INTERVENTIONS:

Patients were randomized to receive either nebulization of ropivacaine 150 mg before surgery or instillation of ropivacaine 150 mg before surgery. Nebulization was performed using the Aeroneb Pro device (Aerogen, Galway, Ireland).

MEASUREMENTS AND MAIN RESULTS:

One hundred forty patients were enrolled, and 123 completed the study. There was no difference between the 2 groups in average morphine consumption (7.3 ± 7.5 mg in the nebulization group vs 9.2 ± 7.2 mg in the instillation group; p = .17). Eighty-two percent of patients in the nebulization group required morphine compared with 96% in the instillation group (p < .05). Patients receiving nebulization had a lower dynamic Numeric Ranking Scale compared with those in the instillation group in the postanesthesia care unit postanesthesia care unit and 4 hours after surgery (p < .05). Ten patients (15%) in the nebulization group experienced shivering in the postanesthesia care unit compared with 2 patients (4%) in the instillation group (p = .035).

CONCLUSION:

Nebulization of ropivacaine prevents the use of morphine in a significant proportion of patients, reduced postoperative pain during the first hours after surgery, and was associated with a higher incidence of postoperative shivering when compared with instillation.

• Authors: Stefano Scalia Catenacci, Federica Lovisari, Shuo Peng, Massimo Allegri, Marta Somaini, Luca Ghislanzoni, Massimiliano Greco, Valeria Rossini, Luca D'Andrea, Alessandro Buda, Mauro Signorelli, Antonio Pellegrino, Debora Sportiello, Dario Bugada, Pablo M Ingelmo
• Journal: Journal of minimally invasive gynecology (J Minim Invasive Gynecol) 2015 Jul-Aug Vol. 22 Issue 5 Pg. 759-66 ISSN: 1553-4669 [Electronic] United States
• PMID: 25820113 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial)
• Copyright: Copyright © 2015 AAGL. Published by Elsevier Inc. All rights reserved.

Chemical References

• Amides
• Anesthetics, Local
• Morphine
• Ropivacaine

Topics

• Adult
• Amides (administration & dosage)
• Anesthetics, Local (administration & dosage)
• Double-Blind Method
• Female
• Gynecologic Surgical Procedures (adverse effects)
• Humans
• Injections, Intraperitoneal
• Laparoscopy (adverse effects)
• Middle Aged
• Morphine (administration & dosage)
• Nebulizers and Vaporizers
• Ovarian Cysts (complications, surgery)
• Pain Measurement
• Pain, Postoperative (drug therapy, etiology)
• Ropivacaine
• Treatment Outcome