scholarly journals Continuous Preperitoneal Infusion of Ropivacaine Provides Effective Analgesia and Accelerates Recovery after Colorectal Surgery

2007 ◽  
Vol 107 (3) ◽  
pp. 461-468 ◽  
Author(s):  
Marc Beaussier ◽  
Hanna El’Ayoubi ◽  
Eduardo Schiffer ◽  
Maxime Rollin ◽  
Yann Parc ◽  
...  
Keyword(s):  
Pain Relief ◽  
Colorectal Resection ◽  
Controlled Trial ◽  
Plasma Concentrations ◽  
Postoperative Recovery ◽  
Morphine Consumption ◽  
Major Surgery ◽  
Preperitoneal Space ◽  
Wound Infiltration ◽  
Open Colorectal Resection

Background Blockade of parietal nociceptive afferents by the use of continuous wound infiltration with local anesthetics may be beneficial in a multimodal approach to postoperative pain management after major surgery. The role of continuous preperitoneal infusion of ropivacaine for pain relief and postoperative recovery after open colorectal resections was evaluated in a randomized, double-blinded, placebo-controlled trial. Methods After obtaining written informed consents, a multiholed wound catheter was placed by the surgeon in the preperitoneal space at the end of surgery in patients scheduled to undergo elective open colorectal resection by midline incision. They were thereafter randomly assigned to receive through the catheter either 0.2% ropivacaine (10-ml bolus followed by an infusion of 10 ml/h during 48 h) or the same protocol with 0.9% NaCl. In addition, all patients received patient-controlled intravenous morphine analgesia. Results Twenty-one patients were evaluated in each group. Compared with preperitoneal saline, ropivacaine infusion reduced morphine consumption during the first 72 h and improved pain relief at rest during 12 h and while coughing during 48 h. Sleep quality was also better during the first two postoperative nights. Time to recovery of bowel function (74 +/- 19 vs. 105 +/- 54 h; P = 0.02) and duration of hospital stay (115 +/- 25 vs. 147 +/- 53 h; P = 0.02) were significantly reduced in the ropivacaine group. Ropivacaine plasma concentrations remained below the level of toxicity. No side effects were observed. Conclusions Continuous preperitoneal administration of 0.2% ropivacaine at 10 ml/h during 48 h after open colorectal resection reduced morphine consumption, improved pain relief, and accelerated postoperative recovery.

High-Dose Ropivacaine Wound Infiltration for Pain Relief After Inguinal Hernia Repair

1998 ◽  
Vol 23 (2) ◽  
pp. 189-196 ◽  
Author(s):  
Nils Pettersson ◽  
B-M Emanuelsson ◽  
Håkan Reventlid ◽  
Robert G. Hahn
Keyword(s):  
Pain Relief ◽  
Hernia Repair ◽  
Plasma Concentrations ◽  
High Dose ◽  
Hernia Surgery ◽  
Wound Infiltration ◽  
Surgeon General ◽  
Pain Scores ◽  
Control Pain ◽  
Pain At Rest

Background and ObjectivesEarly data on ropivacaine, a recently introduced local anesthetic, indicate a longer duration of skin analgesia than with bupivacaine, along with lower toxicity. The objective of this study was to evaluate ropivacaine 7.5 mg/mL for wound infiltration pain relief after hernia surgery, in higher doses than used before, in an open, nonrandomized design.MethodsTwenty otherwise healthy men underwent elective unilateral open hernia repair by the same surgeon. General anesthesia was used during surgery, and infiltration of the operating field with 300 mg (n = 10) or 375 mg (n = 10) ropivacaine, 7.5 mg/mL, was employed for postoperative pain relief. Any sign of an adverse event was recorded. Plasma concentrations of ropivacaine were monitored. Pain at rest and on mobilization was regularly assessed over 24 hours by a visual analog scale. Patients' ability to walk and void and the need for supplementary analgesics were recorded.ResultsNo serious adverse effects occurred. Plasma concentrations showed large variations but no toxic levels. No significant differences between the two groups were detected in pain scores which were low in both groups, at rest or on mobilization, or in the consumption of supplementary analgesics. At 4 hours, 19 patients were able to walk. Within 8 hours of surgery, all patients had passed urine without any problem. Wound healing was normal.ConclusionsInfiltration of ropivacaine 7.5 mg/mL during hernia surgery can be employed safely in doses of 300 mg and 375 mg to control pain after hernia surgery. The lower dose is recommended, since the higher one did not give any clinically relevant advantages.

scholarly journals Effect of Intravenous High Dose Vitamin C on Postoperative Pain and Morphine Use after Laparoscopic Colectomy: A Randomized Controlled Trial

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Younghoon Jeon ◽  
Jun Seok Park ◽  
Suyoung Moon ◽  
Jinseok Yeo
Keyword(s):  
Postoperative Pain ◽  
Vitamin C ◽  
Laparoscopic Colectomy ◽  
Controlled Trial ◽  
Plasma Concentrations ◽  
Antioxidant Properties ◽  
Morphine Consumption ◽  
High Dose ◽  
Significant Difference ◽  
High Dose Vitamin

Background and Objective. Vitamin C has antioxidant, neuroprotective, and neuromodulating effects. Recently, it showed antinociceptive effect as a result of the antioxidant properties. Therefore, we designed this study to assess the effect of intravenous vitamin C on opiate consumption and pain in patients undergoing laparoscopic colectomy.Methods. A total of 100 patients were enrolled and allocated to receive 50 mg/kg vitamin C or placebo by intravenous infusion immediately after induction of anesthesia. Morphine consumption and scores of pain were assessed at 2, 6, and 24 h after completion of surgery.Results. There were 97 patients included in the analysis. Patients who received vitamin C had higher plasma concentrations of vitamin C at the end of surgery, significantly lower morphine consumption at the 2 h after end of surgery, and significantly lower pain scores at rest during first 24 h postoperatively. There was no significant difference between groups in side effects, fatigue score, or pain score during cough.Conclusion. This study shows high dose vitamin C infusion decreased postoperative pain during the first 24 h and reduced morphine consumption in the early postoperative period. Additional research needed to examine whether higher doses of vitamin C and longer infusion times can amplify these effects.

scholarly journals Epidurinės nejautros poveikis skausmo malšinimui ir žarnyno funkcijos atsitaisymui po gaubtinės ir tiesiosios žarnos rezekcijos

2008 ◽  
Vol 6 (3) ◽  
pp. 0-0
Author(s):  
Renatas Tikuišis ◽  
Povilas Miliauskas ◽  
Narimantas Evaldas Samalavičius ◽  
Giedrė Rudinskaitė
Keyword(s):  
Postoperative Pain ◽  
Pain Relief ◽  
Colorectal Surgery ◽  
Epidural Analgesia ◽  
Colorectal Resection ◽  
Solid Food ◽  
Postoperative Pain Relief ◽  
Control Group ◽  
Narcotic Analgesics ◽  
Open Colorectal Resection

Renatas Tikuišis, Povilas Miliauskas, Narimantas Evaldas Samalavičius, Giedrė RudinskaitėVilniaus universiteto Onkologijos institutas, Santariškių g. 1, LT-08660 VilniusEl paštas: [email protected] Įvadas / tikslas Palyginti su sistemine analgezija opiatais, atliekant atviras gaubtinės ir tiesiosios žarnos operacijas, epidurinė nejautra efektyviau malšina skausmą ir ją sukėlus sumažėja pooperacinio žarnų nepraeinamumo dažnis. Šio tyrimo tikslas – nustatyti epidurinės analgezijos poveikį skausmo malšinimui ir žarnyno funkcijos atsitaisymui po gaubtinės ir tiesiosios žarnos operacijų. Ligoniai ir metodai Tyrime dalyvavo 50 ligonių, kuriems buvo atlikta gaubtinės arba tiesiosios žarnos rezekcija. Tai buvo perspektyvusis tyrimas, kuris truko dvejus metus. Atsitiktinės atrankos būdu ligoniai buvo suskirstyti į tiriamąją (T) ir kontrolinę (K) grupes. Po 25 ligonius pateko į kiekvieną grupę. T grupės ligoniams buvo taikyta epidurinė nejautra, o K grupės – švirkščiami narkotiniai analgetikai į veną ir penkis raumenis. Buvo vertinamas narkotinių analgetikų suvartojimas, skausmo intensyvumas po operacijos, žarnyno funkcijos atsitaisymo laikas ir laikas, kai ligonis pradėjo vartoti kietą maistą. Rezultatai Abi grupės pagal operacijos apimtį ir ligonių charakteristiką buvo labai panašios. T grupės ligoniams reikėjo mažiau narkotinių analgetikų, jiems skausmo intensyvumas buvo mažesnis, jų žarnyno veikla atsitaisė anksčiau ir jie anksčiau pradėjo vartoti kietą maistą, palyginti su K grupės ligoniais. Išvada Epidurinės analgezijos metodas yra pranašesnis už intraveninį skausmo malšinimo metodą, taip pat mažiau suvartojama narkotinių analgetikų. Epidurinė analgezija pagreitina žarnyno funkcijos atsitaisymą, todėl ligoniai anksčiau pradeda valgyti kietą maistą po atvirų gaubtinės ir tiesiosios žarnos operacijų. Reikšminiai žodžiai: epidurinė analgezija, intraveninė analgezija, gaubtinės žarnos rezekcija, tiesiosios žarnos rezekcija Influence of epidural analgesia on postoperative pain relief and gastrointestinal recovery after colorectal resection Renatas Tikuišis, Povilas Miliauskas, Narimantas Evaldas Samalavičius, Giedrė RudinskaitėVilnius University, Institute of Oncology, Santariškių str. 1, LT-08660 Vilnius, LithuaniaE-mail: [email protected] Backgound / objective Epidural analgesia provides superior analgesia with a lower incidence of postoperative ileus as compared with systemic opiate analgesia in open colorectal surgery. The aim of this study was to determine the effects of epidural analgesia on the outcome after colorectal surgery. Patients and methods Fifty patients were enrolled in this investigation. Open colorectal resection was performed for all these patients. The patients were randomly assigned into two groups: the study group (T) and the control group (K). Epidural analgesia was used for 25 patients of group T, and intravenous-intramuscular analgesia was used for 25 patients of group K. Consumption of narcotic analgesics, pain intensity, gastrointestinal recovery time and solid food tolerated time were investigated. Results There were no significant differences in the type of operations and preoperative patients’ characteristics between the groups. Consumption of narcotic analgesics was lower in group T, and analgesia was more effective in the epidural group. The mean time of peristalsis and solid food tolerance was earlier in group T as compared with group K. Conclusion Epidural analgesia provides a significant benefit as regards analgesic consumption, postoperative pain relief and the recovery of gastrointestinal function in patients undergoing open colorectal resection. Keywords: epidural analgesia, intravenous analgesia, colorectal surgery

scholarly journals Peritoneal Nebulization of Ropivacaine during Laparoscopic Cholecystectomy: Dose Finding and Pharmacokinetic Study

2017 ◽  
Vol 2017 ◽  
pp. 1-9 ◽  
Author(s):  
Massimo Allegri ◽  
Martina Ornaghi ◽  
Catherine E. Ferland ◽  
Dario Bugada ◽  
Yash Meghani ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
High Performance ◽  
Controlled Trial ◽  
Plasma Concentrations ◽  
Analgesic Efficacy ◽  
Postoperative Nausea And Vomiting ◽  
Dose Finding ◽  
Morphine Consumption ◽  
Double Blind ◽  
Postoperative Morphine

Background. Intraperitoneal nebulization of ropivacaine reduces postoperative pain and morphine consumption after laparoscopic surgery. The aim of this multicenter double-blind randomized controlled trial was to assess the efficacy of different doses and dose-related absorption of ropivacaine when nebulized in the peritoneal cavity during laparoscopic cholecystectomy. Methods. Patients were randomized to receive 50, 100, or 150 mg of ropivacaine 1% by peritoneal nebulization through a nebulizer. Morphine consumption, pain intensity in the abdomen, wound and shoulder, time to unassisted ambulation, discharge time, and adverse effects were collected during the first 48 hours after surgery. The pharmacokinetics of ropivacaine was evaluated using high performance liquid chromatography. Results. Nebulization of 50 mg of ropivacaine had the same effect of 100 or 150 mg in terms of postoperative morphine consumption, shoulder pain, postoperative nausea and vomiting, activity resumption, and hospital discharge timing (>0.05). Plasma concentrations did not reach toxic levels in any patient, and no significant differences were observed between groups (P>0.05). Conclusions. There is no enhancement in analgesic efficacy with higher doses of nebulized ropivacaine during laparoscopic cholecystectomy. When administered with a microvibration-based aerosol humidification system, the pharmacokinetics of ropivacaine is constant and maintains an adequate safety profile for each dosage tested.

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