Preoperative Local Infiltration with Ropivacaine for Postoperative Pain Relief After Cholecystectomy

Abstract

In a randomized, double-blind, placebo-controlled trial, we evaluated the use of preoperative local anesthesia with regard to postoperative pain. Before surgery in 66 patients scheduled for cholecystectomy, the abdominal wall along the proposed line of incision was infiltrated with 70 mL of 0.25% ropivacaine, 70 mL of 0.125% ropivacaine, or 70 mL of saline. Wound pain at rest, wound pain during mobilization, and pressure exerted to reach maximum pain tolerance were assessed after 6, 26, 50, and 74 h and after 7 days. Consumption of analgesics was recorded. At the 6-h assessment, there was a statistically significant dose-related decrease in wound pain during mobilization (P = 0.001) and an increase of pressure exerted to reach maximum pain tolerance (P < 0.001). The tests were two-tailed and performed at a significance level of P < 0.05. There were no significant differences between the groups at later pain control assessments. The median time to first request for postoperative analgesics was significantly shorter (P = 0.014) in the saline group than in the ropivacaine 0.25% group. These effects are suggested to be a residual anesthetic effect of ropivacaine. The study gives no support to the hypothesis that preoperative local anesthetics dampen the inflammatory response and ensuing hyperalgesia.

Comparison of pre- versus post-incision administration of intraplantar indomethacin and MK886 in a rat model of postoperative pain

“…Some studies have reported the efficacy of such "preemptive analgesia" in laboratory animals following pre-surgical administration of opioids or of a local anesthetic (5-7). However, a local anesthetic before or soon after the end of surgery did not change the intensity of pain produced by herniorrhaphy (8) or cholecystectomy (9). Also, differences in the post-surgical pain were not detected in patients submitted to caudal or epidural block, or treated with systemic administration of opioids before or after surgery (10).…”

Atividade preemptiva da infiltração da incisão com ropivacaína a 0,75%, em pacientes submetidos à herniorrafia inguinal

“…In comparing preemptive and postoperative infiltration, it was observed 72% decrease in morphine consumption (1.5 mg versus 5.5 mg) (p < 0.005). Similarly, in a different study 17 , the amount of requested analgesics in the first 24 hours was significantly lower in patients submitted to inguinal hernia repair with ropivacaine infiltration. Similarly, wound infiltration with ropivacaine in laparoscopic cholecystectomy and hernia repair induces satisfactory postoperative analgesia decreasing the need for opioids 20,21 .…”

“…However, although 0.25% and 0.5% concentrations and lower ropivacaine doses have provided effective analgesia after 3 hours, they were less effective in terms of duration, since after 6 hours pain intensity was lower than control only for the 0.5% group. However, 0.125% solution was not more effective than placebo 17,18 . In our study, preemptive and postoperative ropivacaine infiltration has decreased pain intensity, however effectiveness was better with preemptive infiltration.…”

“…The preemptive group, even after anesthetic blockade regression, remained comfortable, probably because their nervous receptors were not sensitized, which promoted better pain control, delaying the first rescue request. Time for first analgesic dose request was significantly lower in patients submitted to inguinal hernia repair with ropivacaine infiltration 17 . Results have shown clear benefit for pain control with ropivacaine infiltration, especially with preemptive infiltration.…”

Pre-emptive infiltration of levobupivacaine is superior to at-closure administration in lumbar laminectomy patients

“…According to this hypothesis, local infiltration and the resulting nerve impulse block prevent nociceptive impulses from reaching the CNS and suppress the sustained state of hyperexcitability responsible for intense postoperative pain [12].…”