Intraperitoneal Local Anesthetic Instillation and Postoperative Infusion Improves Functional Recovery Following Colectomy: A Randomized Controlled Trial

Abstract

We conclude that instillation and infusion of intraperitoneal ropivacaine for patients undergoing colectomy, including by the laparoscopic approach, decreases postoperative pain and improves functional postoperative recovery. We recommend routine inclusion of intraperitoneal local anesthetic into the multimodal analgesia component of enhanced recovery after surgery programs for laparoscopic colectomy. See Video Abstract at http://links.lww.com/DCR/A698.

The LAPLAP study: a randomized placebo‐controlled clinical trial assessing postoperative functional recovery using intraperitoneal local anaesthetic in laparoscopic colorectal surgery

“…[6] Park's trial [7], performed on laparoscopic colectomy, was again smaller, and although it showed significant differences in VAS (at 2 and 4 h postoperatively) and analgesic consumption (< 300 lg over 48 h) it is arguable whether these differences are clinically relevant. Duffield's study [8]revealed improved SRS on days 7 and 30 following laparoscopic colectomy and minor improvements in VAS pain scores, this time up to 48 h. In a larger cohort with complete blinding of clinicians and patients we did not replicate the findings from these previous studies.…”

“…Duffield et al . assessed postoperative infusional IPLA following laparoscopic and open colectomy, and found reduced pain scores and improved SRS in the intervention group.…”

“…Park et al [7] assessed IPLA for laparoscopic colectomy by spraying the peritoneal cavity with ropivacaine at completion of resection, and demonstrated lower pain scores and fentanyl usage to 48 h in the treatment group. Duffield et al [8] assessed postoperative infusional IPLA following laparoscopic and open colectomy, and found reduced pain scores and improved SRS in the intervention group.…”

“…One previous study reported that IPLA may result in less pain and improved surgical recovery following open colectomy, even in the presence of epidural blockade . Two studies in which IPLA was assessed following laparoscopic surgery have demonstrated improved pain scores and surgical recovery scoring, although neither assessed mobility as an outcome measure .…”

Methods of local blockade with lidocaine in cats submitted to laparoscopic ovariectomy

“…They are low-cost drugs, with safe dose margins and low adverse effects (STEAGALL et al, 2019, p. 22). Intraperitoneal and/or incisional administration has demonstrated a reduction in analgesia requirements and immediate post-surgical pain scores in human patients (DUFFIELD et al, 2018(DUFFIELD et al, , p. 1215KAHOKEHR et al, 2011, p. 31) and canines (CAMPAGNOL et al, 2012, p. 428;LAMBERTINI et al, 2018, p. 867) undergoing abdominal surgeries. As for the feline species, there is little evidence on the use of local anesthetics, more specifically in laparoscopic procedures, based on the use of bupivacaine with or without epinephrine (BENITO, 2016a(BENITO, , 2016b(BENITO, , 2018 and lidocaine (ZILBERSTEIN et al, 2008), the most widely used local anesthetic.…”