Korean J Anesthesiol.  2019 Aug;72(4):357-365. 10.4097/kja.d.18.00290.

Intraperitoneal nebulization versus intraperitoneal instillation of ropivacaine for postoperative pain management following laparoscopic donor nephrectomy

• Kumar R
• Nath SS
• Agarwal A

• KMID: 2458321
• DOI: http://doi.org/10.4097/kja.d.18.00290

Abstract

BACKGROUND
Laparoscopic donor nephrectomy is considered less painful than open nephrectomy but is still associated with significant postoperative pain. Studies reported that intraperitoneal instillation of local anesthetics provides uncertain pain relief after laparoscopic surgery. This randomized, double-blind study evaluated the effect of intraperitoneal nebulization of ropivacaine on postoperative pain relief after laparoscopic donor nephrectomy.
METHODS
Sixty patients undergoing elective laparoscopic donor nephrectomy were randomly assigned to receive either an instillation of 20 ml 0.5% ropivacaine after the induction of pneumoperitoneum or nebulization of 5 ml 1% ropivacaine before and after surgery. The primary outcome was the degree of pain relief (static and dynamic) after surgery. The secondary outcomes were postoperative fentanyl consumption, incidence of shoulder pain, unassisted walking and postoperative nausea and vomiting (PONV). Data were collected in the postanesthesia care unit (PACU) and at 6, 24, and 48 h after surgery.
RESULTS
Compared to patients in the instillation group, those in the nebulization group showed significant reductions in postoperative pain and fentanyl consumption, and none complained of significant shoulder pain (visual analog scale score ≥ 30 mm). Within 20 h of surgery, 13.3% of patients in the instillation group and 93.3% in the nebulization group started unassisted walking (absolute risk reduction, 38%; P = 0.001). In the nebulization group, PONV was significantly reduced in the PACU and at 6 h.
CONCLUSIONS
Intraperitoneal nebulization of ropivacaine reduced postoperative pain, fentanyl consumption, referred shoulder pain, and PONV while enabling earlier mobility without any difference in the length of hospital stay.

Keyword

Acute pain; Donor nephrectomy; Instillation; Laparoscopy; Local anesthetics; Ropivacaine

MeSH Terms

Acute Pain
Anesthetics, Local
Double-Blind Method
Fentanyl
Humans
Incidence
Laparoscopy
Length of Stay
Nephrectomy*
Pain, Postoperative*
Pneumoperitoneum
Postoperative Nausea and Vomiting
Risk Reduction Behavior
Shoulder Pain
Tissue Donors*
Walking
Anesthetics, Local
Fentanyl