Intraperitoneal Ropivacaine for Effective Pain Relief after Laparoscopic Appendectomy: A Prospective, Randomized, Double-blind, Placebo-controlled Study

Kang, Hyun; Kim, B-G.

doi:10.1177/147323001003800309

Cited by 28 publications

(35 citation statements)

References 27 publications

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“…1,2 This technique reduces early postoperative analgesic requirements, pain scores, and time to firstintervention analgesia after abdominal surgery in humans. [3][4][5][6][7][8][9][10][11][12] According to meta-analyses and systematic reviews, IP administration of bupivacaine currently is recommended for laparoscopic surgery in humans as an adjuvant analgesic technique. 3,[13][14][15][16] Intraperitoneal administration of bupivacaine can reduce pain scores and blunt surgery-induced stress responses in dogs undergoing ovariohysterectomy.…”

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confidence: 99%

Pharmacokinetics of bupivacaine after intraperitoneal administration to cats undergoing ovariohysterectomy

Benito¹,

Monteiro²,

Beaudry³

et al. 2016

ajvr

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OBJECTIVE To evaluate pharmacokinetics of bupivacaine after IP administration to cats undergoing ovariohysterectomy. ANIMALS 8 healthy cats. PROCEDURES Anesthesia was induced with propofol and maintained with isoflurane. Buprenorphine (0.02 mg/kg, IV) and meloxicam (0.2 mg/kg, SC) were administered. A 20-gauge catheter was inserted into a jugular vein for blood sample collection. A ventral midline incision was made, and a solution of 0.5% bupivacaine (2 mg/kg) diluted with an equal volume of saline (0.9% NaCl) solution (final concentration, 0.25% bupivacaine) was injected into the peritoneal space over the right and left ovarian pedicles and caudal aspect of the uterus before ovariohysterectomy. Cats were monitored for signs of bupivacaine toxicosis. Venous blood samples (2 mL) were collected before (time 0) and 2, 5, 10, 15, 20, 30, 60, 120, and 240 minutes after bupivacaine administration. Plasma bupivacaine concentrations were determined with a liquid chromatography-tandem mass spectrometry method. Pharmacokinetic parameters were determined by data plotting followed by analysis with a noncompartmental model. RESULTS No signs of bupivacaine toxicosis were observed. Maximum bupivacaine plasma concentration was 1,030 ± 497.5 ng/mL at a mean ± SD value of 30 ± 24 minutes after administration. Mean elimination half-life was 4.79 ± 2.7 hours. Mean clearance indexed by bioavailability and volume of distribution indexed by bioavailability were 0.35 ± 0.18 L•h/kg and 2.10 ± 0.84 L/kg, respectively. CONCLUSIONS AND CLINICAL RELEVANCE Intraperitoneal administration of bupivacaine resulted in concentrations that did not cause observable toxicosis. Studies to investigate analgesic effects for this technique in cats are warranted.

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confidence: 99%

Pharmacokinetics of bupivacaine after intraperitoneal administration to cats undergoing ovariohysterectomy

Benito¹,

Monteiro²,

Beaudry³

et al. 2016

ajvr

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“…Studies differ with regard to the type of LA, dosage, method and timing of administration, intraoperative and postoperative pain control protocol, and follow-up parameters. Long-acting local anesthetics have been shown to be efficient for postoperative pain relief in different types of laparoscopic procedures such as cholecystectomy [9] and appendectomy [10]. There are several studies showing conflicting results on the effect of LA instillation following gynecological laparoscopic procedures [10][11][12][13][14][15][16].…”

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confidence: 98%

Pain reduction by continuous intraperitoneal nebulization of ropivacaine during gynecological laparoscopic surgery

et al. 2012

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The objective of this study was to examine the analgesic effect of intraperitoneal nebulization of ropivacaine during gynecological laparoscopic procedures for patients anesthetized with an ultrashort-acting opiate. The study was a double-blinded placebo-controlled randomized trial (Canadian Task Force classification I) and involved 40 patients (20 patients in each arm) undergoing elective gynecological same-day outpatient laparoscopic surgery including unilateral/bilateral salpingo-oophorectomy or unilateral/ bilateral ovarian cystectomy at the University Hospital Ambulatory Gynecological Endoscopic Unit. The study group received 10 ml of 1 % ropivacaine, and the control group received 10 ml of sterile water by intraperitoneal nebulization. Vital signs were recorded and summarized. Postoperatively, patients were followed up for 24 h including visual analogue scale (VAS) scores and analgesic usage. Results showed no significant differences between the two groups in terms of patient characteristics and surgical data. There were no significant differences between the groups in postoperative VAS scores at rest at the different time intervals. VAS scores during strain showed significantly decreased pain at the postoperative 2-h interval (p<0.05). Postoperative opiate and nonopiate analgesia consumption was similar for both groups. Patients in the study groups required more antiemetic agents compared to the control group patients (p<0.05). There were no reported side effects related to ropivacaine. Intraperitoneal nebulization of 100 mg of ropivacaine during gynecological laparoscopy under general anesthesia with an ultrashort-acting opiate does not reduce postoperative pain and it does not reduce postoperative opiate and nonopiate analgesia consumption.

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“…To date, few studies have investigated controlling postoperative pain at operation sites or controlling visceral pain. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] Intraperitoneal local injection has been a focus of studies since the 1950s, and previous studies have used instilled or nebulized delivery modes for peritoneal distribution. 2,5-9 However, these studies have shown few positive results.…”

Section: Discussionmentioning

confidence: 99%

Postoperative pain control with ropivacaine following laparoscopic myomectomy: A randomized double‐blind, pilot study

Kwack

Ahn

Kwon

2019

J of Obstet and Gynaecol

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Aim The aim of this study was to evaluate immediate pain control in patients who underwent laparoscopic myomectomy (LM) by intraoperative injection of ropivacaine into both uterosacral ligaments. Methods The study was a prospective, double‐blind, randomized study. We analyzed 46 cases of LM performed between July 2015 and November 2016 by a single surgeon. We randomized the enrolled patients into either a ropivacaine or a saline injection group. Before the surgeon closed the abdominal wall, each 7.5% ropivacaine (5 mL) or saline (5 mL) was administered into both uterosacral ligaments through laparoscopic injection needle. We compared the pain intensity scores 2, 6, 12, and 24 h after injection between the two groups. Results The pain intensity scores were not significantly different. However, the ropivacaine group requested less of the analgesic than the placebo‐injected group requested (P = 0.035). No patient in the ropivacaine group reported any side effects. Conclusion Intraoperative ropivacaine injection into both uterosacral ligaments during LM can reduce the dosage of opioid analgesics.

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Intraperitoneal Ropivacaine for Effective Pain Relief after Laparoscopic Appendectomy: A Prospective, Randomized, Double-blind, Placebo-controlled Study

Cited by 28 publications

References 27 publications

Pharmacokinetics of bupivacaine after intraperitoneal administration to cats undergoing ovariohysterectomy

Pharmacokinetics of bupivacaine after intraperitoneal administration to cats undergoing ovariohysterectomy

Pain reduction by continuous intraperitoneal nebulization of ropivacaine during gynecological laparoscopic surgery

Postoperative pain control with ropivacaine following laparoscopic myomectomy: A randomized double‐blind, pilot study

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