Intraperitoneal nebulization of ropivacaine for pain control after laparoscopic cholecystectomy

A double-blind, randomized, placebo-controlled trial

P. M. Ingelmo, M. Bucciero, M. Somaini, E. Sahillioǧlu, A. Garbagnati, A. Charton, V. Rossini, V. Sacchi, M. Scardilli, A. Lometti, G. P. Joshi, R. Fumagalli, P. Diemunsch

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

BackgroundIntraperitoneal local anaesthetic nebulization is a relatively novel approach to pain management after laparoscopic surgery. This randomized, double-blind, placebo-controlled trial evaluated the effects of intraperitoneal ropivacaine nebulization on pain control after laparoscopic cholecystectomy. MethodsPatients undergoing laparoscopic cholecystectomy were randomized to receive intraperitoneal nebulization of ropivacaine 1% (3 ml) before surgical dissection and normal saline 3 ml at the end of surgery (preoperative nebulization group); intraperitoneal nebulization of normal saline 3 ml before surgical dissection and ropivacaine 1% (3 ml) at the end of surgery (postoperative nebulization group); or intraperitoneal nebulization of normal saline 3 ml before surgical dissection and at the end of surgery (placebo group). Intraperitoneal nebulization of ropivacaine or saline was performed using the Aeroneb Pro® device. Anaesthetic and surgical techniques were standardized. The degree of pain on deep breath or movement, incidence of shoulder pain, morphine consumption, and postoperative nausea and vomiting were collected in the post-anaesthesia care unit and at 6, 24, and 48 h after surgery.ResultsCompared with placebo, ropivacaine nebulization significantly reduced postoperative pain (-33%; Cohen's d 0.64), referred shoulder pain (absolute reduction -98%), morphine requirements (-41% to -56% Cohen's d 1.16), and time to unassisted walking (up to -44% Cohen's d 0.9) (P<0.01). There were no differences in pain scores between ropivacaine nebulization groups.ConclusionsRopivacaine nebulization before or after surgery reduced postoperative pain and referred shoulder pain after laparoscopic cholecystectomy. Furthermore, ropivacaine nebulization reduced morphine requirements and allowed earlier mobility.

Original languageEnglish (US)
Pages (from-to)800-806
Number of pages7
JournalBritish Journal of Anaesthesia
Volume110
Issue number5
DOIs
StatePublished - May 2013

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Laparoscopic Cholecystectomy
Randomized Controlled Trials
Placebos
Pain
Shoulder Pain
Morphine
Referred Pain
Dissection
Postoperative Pain
Postoperative Nausea and Vomiting
Pain Management
Local Anesthetics
ropivacaine
Laparoscopy
Walking
Anesthetics
Anesthesia
Equipment and Supplies
Incidence

Keywords

  • acute pain
  • anaesthetic techniques
  • analgesics
  • insufflation
  • local anaesthetics
  • postoperative
  • regional
  • regional techniques
  • ropivacaine

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Intraperitoneal nebulization of ropivacaine for pain control after laparoscopic cholecystectomy : A double-blind, randomized, placebo-controlled trial. / Ingelmo, P. M.; Bucciero, M.; Somaini, M.; Sahillioǧlu, E.; Garbagnati, A.; Charton, A.; Rossini, V.; Sacchi, V.; Scardilli, M.; Lometti, A.; Joshi, G. P.; Fumagalli, R.; Diemunsch, P.

In: British Journal of Anaesthesia, Vol. 110, No. 5, 05.2013, p. 800-806.

Research output: Contribution to journalArticle

Ingelmo, PM, Bucciero, M, Somaini, M, Sahillioǧlu, E, Garbagnati, A, Charton, A, Rossini, V, Sacchi, V, Scardilli, M, Lometti, A, Joshi, GP, Fumagalli, R & Diemunsch, P 2013, 'Intraperitoneal nebulization of ropivacaine for pain control after laparoscopic cholecystectomy: A double-blind, randomized, placebo-controlled trial', British Journal of Anaesthesia, vol. 110, no. 5, pp. 800-806. https://doi.org/10.1093/bja/aes495
Ingelmo, P. M. ; Bucciero, M. ; Somaini, M. ; Sahillioǧlu, E. ; Garbagnati, A. ; Charton, A. ; Rossini, V. ; Sacchi, V. ; Scardilli, M. ; Lometti, A. ; Joshi, G. P. ; Fumagalli, R. ; Diemunsch, P. / Intraperitoneal nebulization of ropivacaine for pain control after laparoscopic cholecystectomy : A double-blind, randomized, placebo-controlled trial. In: British Journal of Anaesthesia. 2013 ; Vol. 110, No. 5. pp. 800-806.
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abstract = "BackgroundIntraperitoneal local anaesthetic nebulization is a relatively novel approach to pain management after laparoscopic surgery. This randomized, double-blind, placebo-controlled trial evaluated the effects of intraperitoneal ropivacaine nebulization on pain control after laparoscopic cholecystectomy. MethodsPatients undergoing laparoscopic cholecystectomy were randomized to receive intraperitoneal nebulization of ropivacaine 1{\%} (3 ml) before surgical dissection and normal saline 3 ml at the end of surgery (preoperative nebulization group); intraperitoneal nebulization of normal saline 3 ml before surgical dissection and ropivacaine 1{\%} (3 ml) at the end of surgery (postoperative nebulization group); or intraperitoneal nebulization of normal saline 3 ml before surgical dissection and at the end of surgery (placebo group). Intraperitoneal nebulization of ropivacaine or saline was performed using the Aeroneb Pro{\circledR} device. Anaesthetic and surgical techniques were standardized. The degree of pain on deep breath or movement, incidence of shoulder pain, morphine consumption, and postoperative nausea and vomiting were collected in the post-anaesthesia care unit and at 6, 24, and 48 h after surgery.ResultsCompared with placebo, ropivacaine nebulization significantly reduced postoperative pain (-33{\%}; Cohen's d 0.64), referred shoulder pain (absolute reduction -98{\%}), morphine requirements (-41{\%} to -56{\%} Cohen's d 1.16), and time to unassisted walking (up to -44{\%} Cohen's d 0.9) (P<0.01). There were no differences in pain scores between ropivacaine nebulization groups.ConclusionsRopivacaine nebulization before or after surgery reduced postoperative pain and referred shoulder pain after laparoscopic cholecystectomy. Furthermore, ropivacaine nebulization reduced morphine requirements and allowed earlier mobility.",
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AU - Somaini, M.

AU - Sahillioǧlu, E.

AU - Garbagnati, A.

AU - Charton, A.

AU - Rossini, V.

AU - Sacchi, V.

AU - Scardilli, M.

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