The Impact of Laparoscopic Intraperitoneal Instillation of Ropivacaine in Enhancing Respiratory Recovery and Reducing Acute Postoperative Pain in Laparoscopic Sleeve Gastrectomy: a Double-Blinded Randomised Control; RELiEVE Trial

Enhanced analgesic efficacy and reduced stress response with ropivacaine transversus abdominis plane block in laparoscopic myomectomy

BACKGROUND

Managing postoperative pain and stress response was critical in laparoscopic myomectomy, a procedure for uterine fibroids. Ropivacaine transversus abdominis plane block (RTAPB) may offer enhanced analgesic efficacy and reduced stress responses compared to traditional analgesia.

METHODS

This retrospective analysis examined 217 patients undergoing laparoscopic myomectomy at Hankou Hospital of Wuhan from June 2020 to September 2023. Patients were divided into routine analgesia (CA, n = 105) and RTAPB (n = 112) groups. Pain levels were assessed using the Visual Analog Scale (VAS). Stress hormone levels (cortisol, norepinephrine, Interleukin-6), preoperative and postoperative recovery, sleep quality, hemodynamic stability, complications, and patient satisfaction were evaluated post-surgery.

RESULTS

The RTAPB group demonstrated significantly lower postoperative VAS pain scores at all measured intervals (P < 0.05). Stress hormones (postoperative cortisol, norepinephrine, and IL-6) were substantially lower in the RTAPB group compared to CA (P < 0.05), indicating reduced stress response. Intraoperative hemodynamic stability was improved with RTAPB, reflected in lower heart rate and mean arterial pressure (P < 0.05). Postoperative recovery and sleep quality were also better in the RTAPB group, as evidenced by higher QoR-40 and lower PSQI scores (P < 0.01). Although not statistically significant, RTAPB showed a trend toward fewer complications. Patient satisfaction, particularly with pain management, was significantly higher in the RTAPB group (P < 0.001).

CONCLUSION

RTAPB significantly enhances analgesic efficacy and moderates the physiological stress response in laparoscopic myomectomy patients compared to routine analgesia.