Intraperitoneal Subdiaphragmatic Ropivacaine Instillation for Prevention of Shoulder Tip Pain After Laparoscopic Surgery in High-Risk Patients: A Randomized Controlled Trial

Objective: To evaluate the efficacy of intraperitoneal subdiaphragmatic instillation of ropivacaine on shoulder tip pain (STP) or upper abdominal pain postoperatively after gynecological laparoscopic surgery. Design: It was a parallel-arm randomized controlled trial conducted in a private tertiary care center between October 2017 and January 2020. A total of 118 participants in two study groups were analyzed. Materials and Methods: Women in the study group (Group A) received 40 mL of 0.2% ropivacaine, sprayed under the diaphragm immediately after the creation of pneumoperitoneum. Women in the control group (Group B) did not. Postoperative STP was assessed by using the visual analogue scale at 1, 4, 12, and 20 hours after surgery. The pain scores and requirement of postoperative analgesia were compared between the two groups. Results: Incidence of STP or upper abdominal pain was significantly higher in the control arm at 12 hours (Intervention arm: 7.4% vs. Control arm: 21.9%; p = 0.039) and at 20 hours (Intervention arm: 3.7% vs. Control arm: 17.2%; p = 0.035) post-surgery. Number needed to treat was calculated as 6.9. An individual in the intervention arm was found to be 75% more protected from the incidence of pain after adjusting for time and individual level clustering (adjusted incidence rate ratio: 0.25, 95% confidence interval: 0.10-0.68, p = 0.006) than the control arm. Conclusion: Intraperitoneal subdiaphragmatic instillation of ropivacaine in fertility-preserving laparoscopic surgeries among high-risk patients reduces the incidence of postoperative STP or upper abdominal pain. (J GYNECOL SURG 00:000).