Can ropivacaine be effectively and safely used in analgesia after laparoscopically assisted gastrointestinal surgery?

Objective

This prospective observer-blinded clinical trial is designed to evaluate the effectiveness and the safety of 0.5% ropivacaine 30 ml (150 mg) administrated via subcutaneous infiltration at incision with or without combination of intraperitoneal spray for analgesia after laparoscopically assisted gastrointestinal surgery.

Methods

Ninety ASA grade I–III patients were randomized into three groups: Group R1 (29 patients) in which patients received infiltration of 0.5% ropivacaine 30 ml at all incision sites before the suturing, Group R2 (31 patients) in which patients received 0.5% ropivacaine 20 ml at all incision sites and intraperitoneal spray of 0.5% ropivacaine 10 ml before the suturing and Group C (30 patients) in which patients received no ropivacaine as control. VAS scores at rest and during coughing were recorded immediately after emergence (H0), at 2 h (H2), 4 h (H4), 6 h (H6) and 24 h (H24) after operation. Serum cortisol concentration of cortisol was measured preoperatively (F0) and 2 h after operation (F2). Subcutaneous pethidine blouses given for additional pain treatment were counted for the first 24 h after operation and follow-up examination of incisions were performed at the 1st, 4th, 7th day after operation.

Results

Within 6 h postoperatively, the patients in Groups R1 and R2 reported significantly lower VAS scores at rest and during coughing than those in Group C (P < 0.05). Serum cortisol concentrations at 2 h (F2) after operation were significantly lower in Group R2 than in Group C. There was no difference among the three groups in administration of pethidine boluses within 6 h and 24 h after the surgery. In this trial, no neurological or cardiac complications were observed in any patient.

Conclusion

Thirty millilitres of 0.5% ropivacaine can be used effectively and safely for pain control in the early hours after laparoscopically assisted gastrointestinal surgery and subcutaneous infiltration at incision sites combined with intraperitoneal spray can provide more complete analgesia. However, analgesia provided by ropivacaine via subcutaneous infiltration at incision sites with or without intraperitoneal spray would gradually become less effective 6 h after the operation, hence requiring additional pain treatment.