Pain relief by continuous intraperitoneal nebulization of ropivacaine during gynecologic laparoscopic surgery - A randomized study and review of the literature

Study Objective: To evaluate the efficacy of intraperitoneal nebulization of ropivacaine on pain relief during and after gynecologic laparoscopic procedures including a review of the literature. Design: Double-blinded, randomized, controlled, clinical trial (Canadian Task Force classification 1). Setting: University hospital ambulatory gynecoendoscopic department. Patients: Forty patients (20 patients in each arm) undergoing elective gynecologic same-day outpatient laparoscopic surgery including unilateral/bilateral salpingo-oophorectomy or unilateral/bilateral ovarian cystectomy. Interventions: The study group received 10 mL of 1% ropivacaine and the control group received 10 mL of sterile water by intraperitoneal nebulization. During surgery, vital signs were recorded and summarized. Postoperatively patients were followed up for 24 hours including Visual analog scale scores and analgesic use. Measurements and Main Results: No significant differences existed between the groups during surgery and at the recovery department in terms of arterial blood pressure (p =.42) or heart rate (p =.60). Regarding postoperative analgesia, no difference existed between the groups in terms of morphine consumption (p =.52) or other analgesics (p =.53). No significant difference existed between the groups in postoperative visual analog scale scores including visceral, abdominal wall, and shoulder pain during rest and during Cough at the different time frames (30, 60, and 120 minutes and 6 and 24 hours after surgery). Conclusion: Out study is the first to examine the effects of intraperitoneal nebulization of ropivacaine throughout laparoscopic gynecologic procedures on patients undergoing general anesthesia. Nebulization of 100 mg of ropivacaine under our specific regimen of anesthesia does not improve patients' outcome in terms of intraoperative and postoperative pain along with consumption of analgesics. Further research with other regimens is required.