Randomized controlled study of intraincisional infiltration versus intraperitoneal instillation of standardized dose of ropivacaine 0.2% in post-laparoscopic cholecystectomy pain: Do we really need high doses of local anesthetics—time to rethink!

Kaushal-Deep, S.M. and Anees, A. and Khan, S. and Khan, M.A. and Lodhi, M. (2018) Randomized controlled study of intraincisional infiltration versus intraperitoneal instillation of standardized dose of ropivacaine 0.2% in post-laparoscopic cholecystectomy pain: Do we really need high doses of local anesthetics—time to rethink! Surgical Endoscopy and Other Interventional Techniques. pp. 1-21. ISSN 9302794

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Official URL: https://link.springer.com/article/10.1007%2Fs00464...

Abstract

Background: Earlier studies done to compare the efficacy of use of local anesthetics at intraperitoneal location versus intraincisional use had utilized equal amount of drugs at the two locations, usually 10–20 ml. Using this large amount of drug in the small space of intraincisional location as compared to similar amount of drug in large intraperitoneal space created an inadvertent bias in favor of patients receiving the drug intraincisionally so these patients naturally experienced less pain. Aims and objectives: To conduct a randomized, triple-blind, placebo-controlled study by standardizing dose of local anesthetic, to compare the effectiveness of intraperitoneal against intraincisional use of ropivacaine 0.2% for post-laparoscopic cholecystectomy pain relief. Materials and methods: 294 patients underwent elective 4-port laparoscopic cholecystectomy. Patients were triple blindly randomized. All patients received ~ 23 ml of solution, of which 20 ml was given intraperitoneally (1 ml/cm; 16 ml along right hemi-dome and 4 ml in gall bladder fossa) and ~ 3 ml intraincisionally (1 ml/cm of length of incision). Solution was either normal saline or drug (0.2% ropivacaine) depending on the group [controls (n = 86), intraperitoneal group (n = 100), and intraincisional group (n = 108)]. 5 different pain scales were used for assessment of overall pain. Pain scores were assessed at 5 points of time. Results: Patients in intraincisional group showed significantly less overall pain and rescue analgesia requirement (p < 0.05). Intraincisional group showed significantly less overall pain (p < 0.05) as compared to intraperitoneal group; however, use of rescue analgesia was comparable in the two groups (p > 0.05); and shoulder pain was significantly less in intraperitoneal group (p < 0.05). Conclusion: The intraincisional use of injection ropivacaine at its minimum concentration of 0.2% in minimal doses of 1 ml/cm at the end of procedure provides significantly more post-operative analgesia as compared to intraperitoneal group and controls. However, for controlling shoulder pain, the use of intraperitoneal ropivacaine is desirable.

Item Type: Article
Uncontrolled Keywords: Intraincisional infiltration; Intraperitoneal instillation; Local anesthesia; Post-laparoscopic cholecystectomy pain; Rescue analgesia; Ropivacaine; Shoulder pain
Subjects: R Medicine > RD Surgery
Divisions: Faculties > Faculty of Medicine > J.N. Medical College > Department of Surgery
Depositing User: AMU Library
Date Deposited: 01 Feb 2018 06:16
Last Modified: 01 Feb 2018 06:16
URI: http://ir.amu.ac.in/id/eprint/11050

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