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Buyukasik S, Kankaya B, Altundal YE, Ozgul M, Alis H. Exploring the Gender-Specific Impact of Intraperitoneal Bupivacaine on Early Postoperative Pain in Sleeve Gastrectomy. J Laparoendosc Adv Surg Tech A 2023; 33:1040-1046. [PMID: 37695818 DOI: 10.1089/lap.2023.0217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023] Open
Abstract
Background: Early postoperative pain is a significant problem in bariatric and metabolic surgery. Our study aimed to investigate the potential role of intraperitoneal bupivacaine hydrochloride in pain management in the early postoperative period after bariatric and metabolic surgery. Methods: This double-blind, prospective, randomized, controlled study included 68 individuals who underwent bariatric and metabolic surgery at the Department of Surgery, Istanbul Aydin University Hospital. The study group received 20 mL of 0.5% bupivacaine hydrochloride intraperitoneally at the operative site, and the control group received 20 mL of normal saline. Visual analog scale (VAS) scores of each patient were recorded at 2nd, 4th, and 6th hours postoperatively. Results: Our study found significant differences in VAS scores of patients between study group and control group at 2nd, 4th, and 6th hours postoperatively. Significant differences were found between male and female patients in the control group at 2nd, 4th, and 6th hours postoperatively. Interestingly, no significant difference was found between female patients in the study group and control group at 2nd, 4th, and 6th hours postoperatively. Conclusions: Our study suggests that intraperitoneal administration of bupivacaine hydrochloride is effective in reducing early postoperative pain in male patients. However, no significant difference was found between the study group and the control group in female patients. Our results indicate that there may be a gender-related difference in the response to bupivacaine administration. Further research is needed to confirm these findings and determine the optimal dosing and administration of local anesthetics for postoperative pain management.
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Affiliation(s)
- Suleyman Buyukasik
- Department of General Surgery, Faculty of Medicine, Istanbul Aydin University, Istanbul, Turkey
| | - Burak Kankaya
- Department of General Surgery, Faculty of Medicine, Istanbul Aydin University, Istanbul, Turkey
| | - Yusuf Emre Altundal
- Department of General Surgery, Faculty of Medicine, Istanbul Aydin University, Istanbul, Turkey
| | - Mustafa Ozgul
- Department of Ophthalmology, Gavin Herbert Eye Institute, University of California Irvine, Irvine, California, USA
| | - Halil Alis
- Department of General Surgery, Faculty of Medicine, Istanbul Aydin University, Istanbul, Turkey
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Sandhya S, Puthenveettil N, Vinodan K. Intraperitoneal nebulization of ropivacaine for control of pain after laparoscopic cholecystectomy -A randomized control trial. J Anaesthesiol Clin Pharmacol 2021; 37:443-448. [PMID: 34759559 PMCID: PMC8562463 DOI: 10.4103/joacp.joacp_358_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 01/04/2021] [Accepted: 03/07/2021] [Indexed: 11/11/2022] Open
Abstract
Background and Aims: Use of high dose opioids following laparoscopic surgery delays discharge from the hospital. Unlike intraperitoneal instillation, nebulization has been reported to provide a homogeneous spread of local anesthetics and provide better analgesia. In our study, we aimed to assess the efficacy of intraperitoneal nebulization of local anesthetic in alleviating postoperative pain in patients undergoing laparoscopic cholecystectomy. Material and Methods: This randomized control double-blinded study was conducted after obtaining approval from the hospital ethics committee and informed consent from patients undergoing laparoscopic cholecystectomy under general anesthesia. Patients recruited were divided into two equal groups of 20 each. Group B received intraperitoneal nebulization with 4 ml of 0.75% ropivacaine and Group C received intraperitoneal nebulization with 4ml of saline before surgical dissection. Postoperative pain score using a numeric rating scale was monitored until 24 h, the need for rescue analgesics and associated complications were noted. Chi-square test, Student's test, and Mann–Whitney U test were used for statistical analysis. Results: The pain score was significantly less in Group B during rest and deep breathing up to 24 h with a P value <0.05. The pain score on movement was also less in Group B and this difference was statistically significant at 6 and 24 h (P = 0.004 and 0.005, respectively). Tramadol consumption was less in Group B and was statistically significant at 24 h with P value of 0.044. No adverse events were noted. Conclusion: Intraperitoneal nebulization of ropivacaine is effective and safe in providing postoperative analgesia in patients undergoing laparoscopic cholecystectomy.
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Affiliation(s)
- Sai Sandhya
- Department of Anaesthesia and Critical Care, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Nitu Puthenveettil
- Department of Anaesthesia and Critical Care, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - K Vinodan
- Department of Anaesthesia and Critical Care, Medical Trust Hospital Kochi, Kerala, India
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Major AL, Jumaniyazov K, Yusupova S, Jabbarov R, Saidmamatov O, Mayboroda-Major I. Laparoscopy in Gynecologic and Abdominal Surgery in Regional (Spinal, Peridural) Anesthesia, the Utility of the Technique during COVID-19 Pandemic. MEDICINES (BASEL, SWITZERLAND) 2021; 8:60. [PMID: 34677489 PMCID: PMC8541053 DOI: 10.3390/medicines8100060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/07/2021] [Accepted: 10/12/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND laparoscopic surgery is mainly performed in general anesthesia. Symptomatic patients infected with COVID-19 needing surgery are however at higher risk for COVID-19 complications in general anesthesia than in regional anesthesia. Even so, Covid transfection is a hazard to medical personnel during the intubation procedure and treatment drugs may be in shortage during a pandemic. Recovery and hospital stay are also shorter after laparoscopy. Laparoscopy performed in regional anesthesia may have several advantages in limiting Covid. METHODS international literature on the risk of COVID-19 complications development was searched. 3 topics concerning laparoscopic surgery were reviewed: (1) Achievements in laparoscopy; (2) Advantages of regional anesthesia compared to general anesthesia; (3) Feasibility to perform laparoscopy in regional anesthesia in COVID-19 pandemic. The authors reviewed abstracts and full-text articles concerning laparoscopic surgery, gynecology, anesthesia and COVID-19. Studies published in PubMed, Embase, Cochrane Library and found in Google Scholar before 1st FEB, 2021 were retrieved and analyzed. RESULTS a total of 83 studies were found, all of them written in English. 17 studies could be found in gynecology and in general surgery about laparoscopy with regional anesthesia. In Covid time only one study compared laparoscopic surgery in general anesthesia to laparotomy and another study laparotomy in general anesthesia to regional anesthesia. Laparoscopy showed no disadvantage compared to laparotomy in Covid pandemic and in another study laparotomy in general anesthesia was associated with higher mortality and more pulmonary complications. Trendelenburg position can be a threat if used by inexperienced personnel and can induce unintended anesthesia of breathing organs. On the other hand Trendelenburg position has advantages for cardiovascular and pulmonary functions. Pneumoperitoneum of low CO2 pressure is well tolerated by patients. CONCLUSIONS elective surgery should be postponed in symptomatic Covid patients. In inevitable emergency surgery intubation anesthesia in COVID-19 pandemic is as far as possible to be avoided. In COVID-19 pandemic, regional anesthesia is the preferred choice. The optimum may be the combination of laparoscopic surgery with regional anesthesia. Reducing the pneumoperitoneum is a good compromise for the comfort of patients and surgeons. A special case is gynecology, which needs to be performed in Trendelenburg position to free pelvic organs.
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Affiliation(s)
- Attila Louis Major
- Femina Gynecology Centre, CH-1205 Geneva, Switzerland
- Department of Obstetrics & Gynecology, University of Fribourg, CH-1700 Fribourg, Switzerland
| | - Kudrat Jumaniyazov
- Department of Obstetrics and Gynecology, Urgench Branch of Tashkent Medical Academy, Urgench 220100, Uzbekistan; (K.J.); (S.Y.); (R.J.)
| | - Shahnoza Yusupova
- Department of Obstetrics and Gynecology, Urgench Branch of Tashkent Medical Academy, Urgench 220100, Uzbekistan; (K.J.); (S.Y.); (R.J.)
| | - Ruslan Jabbarov
- Department of Obstetrics and Gynecology, Urgench Branch of Tashkent Medical Academy, Urgench 220100, Uzbekistan; (K.J.); (S.Y.); (R.J.)
| | - Olimjon Saidmamatov
- Faculty of Tourism and Economics, Urgench State University, Urgench 220100, Uzbekistan
| | - Ivanna Mayboroda-Major
- Department of Gynecology and Obstetrics, University Hospital of Geneva, CH-1205 Geneva, Switzerland
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Hirsch M, Tariq L, Duffy JM. Effect of Local Anesthetics on Postoperative Pain in Patients Undergoing Gynecologic Laparoscopy: A Systematic Review and Meta-analysis of Randomized Trials. J Minim Invasive Gynecol 2021; 28:1689-1698. [PMID: 33991671 DOI: 10.1016/j.jmig.2021.04.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 04/29/2021] [Accepted: 04/30/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Pain remains a common complication after gynecologic laparoscopy. Use of local anesthesia may be beneficial in reducing postoperative pain. We performed a systematic review and meta-analysis to assess whether local anesthetic decreases postoperative pain after laparoscopic gynecologic procedures. DATA SOURCES We searched Cumulative Index to Nursing and Allied Health Literature, Embase, and Medline from inception to November 2020 using Medical Subject Headings and free text combinations. METHODS OF TRIAL SELECTION We included randomized controlled trials of patients undergoing gynecologic laparoscopy receiving port site subcutaneous, subfascial, or intraperitoneal local anesthetic compared with placebo or no intervention. We included 20 trials (1861 participants) with size varying between 28 and 164 participants. TABULATIONS, INTEGRATION, AND RESULTS Meta-analysis was performed with RevMan 5.3 (Cochrane Collaboration, London, United Kingdom), with standard mean differences (SMDs) and random-effects model. Port site infiltration reduces postoperative pain at 4 hours (SMD -0.25; 95% confidence interval [CI], -0.44 to -0.06; 4 trials; 545 participants) and 6 hours (SMD -0.44; 95% CI, -0.82 to -0.06; 4 trials; 455 participants) after surgery. The administration of intraperitoneal local anesthetics reduces pain at 6 hours (-1.42; 95% CI, -3.22 to -0.30; 4 trials; 277 participants) after surgery. CONCLUSIONS The use of port site and intraperitoneal local anesthetic decreases immediate postoperative pain in patients undergoing gynecologic laparoscopy, although its impact on analgesia requirements is unclear. Routine usage of local anesthetics should be considered for people undergoing gynecologic laparoscopy.
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Affiliation(s)
- Martin Hirsch
- EGA Institute for Women's Health (Dr. Hirsch), University College London; Oxford University Hospitals (Dr. Hirsch), Headley way, Oxford, United Kingdom.
| | - Laiba Tariq
- University College London Medical School (Ms. Tariq)
| | - James Mn Duffy
- King's Fertility (Dr. Duffy), Fetal Medicine Research Institute
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Abu-Zaid A, Alomar O, Abuzaid M, Magzoub D, Al-Badawi IA, Salem H. Intraoperative local injection of uterosacral ligaments with ropivacaine during uterine surgery: A systematic review and meta-analysis of randomized controlled trials. J Gynecol Obstet Hum Reprod 2021; 50:102077. [PMID: 33548576 DOI: 10.1016/j.jogoh.2021.102077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 01/25/2021] [Indexed: 10/22/2022]
Abstract
AIM To perform a systematic review and meta-analysis of all randomized controlled trials that examined the efficacy of intraoperative local injection of the uterosacral ligaments with ropivacaine on postoperative pain and opioids consumption in patients undergoing uterine surgery for hysterectomy/myomectomy. METHODS PubMed, Scopus, Web of Science and Cochrane Library databases were screened from inception to September 5th, 2020. We appraised the risk of bias using the Cochrane's risk of bias tool. Resting postoperative pain scores and cumulative consumption of postoperative opioids were regarded as continuous data, analyzed using the inverse variance method and reported as standardized mean difference (SMD) and weighted mean difference (MD), respectively, with 95 % confidence intervals (95 % CIs). RESULTS Five studies met the inclusion criteria comprising 230 patients (117 and 113 patients received ropivacaine and placebo, respectively). The studies had an overall low risk of bias. Resting postoperative pain scores were not significantly different between both groups at 2 h (SMD = -0.30, 95 % CI [-0.70, 0.11], p = 0.15), 12 h (SMD = 0.04, 95 % CI [-0.26, 0.37], p = 0.81) and 24 h (SMD = -0.06, 95 % CI [-0.32, 0.20], p = 0.68). However, the ropivacaine group had significantly reduced cumulative opioid consumption during the first 24 h postoperatively (MD = -9.07, 95 % CI [-14.47, -3.66], p = 0.001). CONCLUSION Intraoperative local infiltration of uterosacral ligaments with ropivacaine is technically feasible and significantly reduces postoperative opioid consumption in women undergoing gynecologic surgery of the uterus.
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Affiliation(s)
- Ahmed Abu-Zaid
- College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, TN, United States; Department of Obstetrics and Gynecology, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
| | - Osama Alomar
- Department of Obstetrics and Gynecology, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia; Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
| | - Mohammed Abuzaid
- Department of Obstetrics and Gynecology, King Fahad Medical City, Riyadh, Saudi Arabia.
| | - Duha Magzoub
- School of Public Health, The University of Memphis, Memphis, TN, United States.
| | - Ismail A Al-Badawi
- Department of Obstetrics and Gynecology, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia; Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
| | - Hany Salem
- Department of Obstetrics and Gynecology, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia; Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
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Simultaneous Determination of Ropivacaine and 3-Hydroxy Ropivacaine in Cerebrospinal Fluid by UPLC-MS/MS. BIOMED RESEARCH INTERNATIONAL 2020; 2020:8844866. [PMID: 33490261 PMCID: PMC7787762 DOI: 10.1155/2020/8844866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/19/2020] [Accepted: 11/25/2020] [Indexed: 11/17/2022]
Abstract
In this paper, a UPLC-MS/MS method was developed for the determination of ropivacaine and its metabolite 3-hydroxy ropivacaine in cerebrospinal fluid. The cerebrospinal fluid was processed by ethyl acetate liquid-liquid extraction. The multiple reaction monitoring (MRM) mode was used for quantitative analysis by monitoring the transitions of m/z 275.3 → 126.2 for ropivacaine, m/z 291.0 → 126.0 for 3-hydroxy ropivacaine, and m/z 290.2 → 198.2 for the internal standard. Standard curves for ropivacaine and 3-hydroxy ropivacaine in cerebrospinal fluid were conducted over the concentration range of 0.2–2000 ng/mL, demonstrating excellent linearity, and the lower limit of quantification was 0.2 ng/mL. The intraday precision of ropivacaine and 3-hydroxy ropivacaine was less than 11%, while the interday precision was less than 7%. The accuracy ranged between 87% and 107%, the average extraction efficiency was higher than 79%, and the matrix effect was between 89% and 98%. The developed method was then applied to a case of suspected poisoning of ropivacaine.
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Malouhi A, Aschenbach R, Erbe A, Owsianowski Z, Rußwurm S, Runnebaum IB, Teichgräber U. Effectiveness of Superior Hypogastric Plexus Block for Pain Control Compared to Epidural Anesthesia in Women Requiring Uterine Artery Embolization for the Treatment of Uterine Fibroids - A Retrospective Evaluation. ROFO-FORTSCHR RONTG 2020; 193:289-297. [PMID: 32882725 DOI: 10.1055/a-1231-5649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To assess the effectiveness of pain management with superior hypogastric plexus block (SHPB) compared to epidural anesthesia (EDA) in women requiring uterine artery embolization (UAE). MATERIALS AND METHODS In this retrospective, single-center, non-randomized trial we included 79 women with symptomatic uterine fibroids who were scheduled for percutaneous, transcatheter UAE. According to their informed decision, the women were assigned to two different approaches of pain management including either SHPB or EDA. The effectiveness outcome measure was patient reported pain using a numeric rating scale ranging from 1 to 10. The pain score was assessed at UAE, 2 hours thereafter, and at subsequent intervals of 6 hours up to 36 hours after intervention. RESULTS Treatment groups did not differ significantly regarding age, pain score for regular menstrual cramps, uterine fibroid size, location, and symptoms of uterine fibroids. During UAE and up to 6 hours thereafter, women who received SHPB experienced stronger pain than those who received EDA (mean pain score during UAE: 3.3 vs. 1.5, p < 0.001; at 2 hours: 4.4 vs. 2.8, p = 0.012; at 6 hours: 4.4 vs. 2.6, p = 0.021). The maximum pain level was 5.8 ± 2.9 with SHPB and 4.5 ± 2.9 with EDA (p = 0.086). Women with a history of severe menorrhagia tended to experience worse pain than those without (regression coefficient 2.5 [95 % confidence interval -0.3 to 5.3], p = 0.076). CONCLUSION Among women who underwent UAE, pain management including SHPB resulted in stronger pain during and after the procedure than pain treatment including EDA. KEY POINTS · Pain control with superior hypogastric plexus block was worse than epidural anesthesia.. · Peak of pain was at 12 hours after uterine artery embolization.. · Maximum pain was independent from uterine fibroid size or location.. CITATION FORMAT · Malouhi A, Aschenbach R, Erbe A et al. Effectiveness of Superior Hypogastric Plexus Block for Pain Control Compared to Epidural Anesthesia in Women Requiring Uterine Artery Embolization for the Treatment of Uterine Fibroids - A Retrospective Evaluation. Fortschr Röntgenstr 2021; 193: 289 - 297.
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Affiliation(s)
- Amer Malouhi
- Institut für Diagnostische und Interventionelle für Radiologie, Universitätsklinikum Jena IDIR, Jena, Germany
| | - Rene Aschenbach
- Institut für Diagnostische und Interventionelle für Radiologie, Universitätsklinikum Jena IDIR, Jena, Germany
| | - Anna Erbe
- Institut für Diagnostische und Interventionelle für Radiologie, Universitätsklinikum Jena IDIR, Jena, Germany
| | | | - Stefan Rußwurm
- Abteilung für Anästhesie, Hufeland Klinikum GmbH, Bad Langensalza, Germany
| | - Ingo B Runnebaum
- Klinik für Frauenheilkunde und Fortpflanzungsmedizin, Universitätsklinikum, Jean, Germany
| | - Ulf Teichgräber
- Institut für Diagnostische und Interventionelle für Radiologie, Universitätsklinikum Jena IDIR, Jena, Germany
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Amer GF, Hamed H, Salim MS, Hegazy MA. Effect of Adding Hydrocortisone to Intraperitoneal Bupivacaine in Laparoscopic Bariatric Surgery. Anesth Essays Res 2020; 14:137-142. [PMID: 32843807 PMCID: PMC7428115 DOI: 10.4103/aer.aer_141_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 11/24/2019] [Accepted: 11/27/2019] [Indexed: 12/03/2022] Open
Abstract
Background: Bariatric surgery is the effective management of obesity; however, postoperative pain is associated with a great morbidity. The management of pain is important for the enhancement of patient recovery. Local anesthetics can be injected during laparoscopic surgery into the peritoneum throughout the ports produced either before the beginning of laparoscopy or before the closure of the wound to reduce postoperative pain. Our aim is to evaluate if there is an additive analgesic effect by the administration of intraperitoneal hydrocortisone with streamed intraperitoneal bupivacaine as a method of postoperative pain relief in laparoscopic bariatric surgeries. Patients and Methods: One hundred patients listed for laparoscopic bariatric surgery were the subject of this study. Patients were randomly allocated into two groups: Group I received 100 mg of 0.5% isobaric bupivacaine plus 20 mL normal saline intraperitoneally and Group II received intraperitoneal 100 mg of 0.5% isobaric bupivacaine + 100 mg hydrocortisone + 20 mL of saline at the end of the laparoscopic procedure. The primary outcome was the Visual Analog Scale (VAS) score for pain. The secondary outcomes were the time of first analgesic request, total opioid requirement, heart rate, and mean blood pressure. Results: VAS showed a significant decrease at 4, 6, and 12 h postoperative in Group II compared to Group I. There was a marked decrease in total meperidine requirement with prolonged time of the first analgesic request in Group II compared to Group I. Conclusion: Intraperitoneal hydrocortisone with bupivacaine had improved postoperative pain relief with a decrease in analgesic requirement.
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Affiliation(s)
- Ghada F Amer
- Department of Anaesthesia and Surgical Intensive Care, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Hosam Hamed
- Department of General Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - M Said Salim
- Department of General Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohammed A Hegazy
- Department of Anaesthesia and Surgical Intensive Care, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Hosseinzadeh F, Nasiri E, Behroozi T. Investigating the effects of drainage by hemovac drain on shoulder pain after female laparoscopic surgery and comparison with deep breathing technique: a randomized clinical trial study. Surg Endosc 2020; 34:5439-5446. [PMID: 31932939 DOI: 10.1007/s00464-019-07339-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 12/24/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND The incidence of shoulder pain following laparoscopic surgery has been reported to be high. This study was designed to investigate the effect of Hemovac drain on postoperative pain of women after laparoscopic surgery, dose of postoperative drug, duration of hospitalization as well as comparison with deep breathing technique. METHODS In this clinical trial, one hundred and fourteen female patients treated by laparoscopy were randomly assigned to three groups of 38 patients. In our study group, the Hemovac drain was implemented from the secondary trocar site with a closed system. In the deep breathing group, the patient was asked to breathe slowly and deeply three time per hour at full vigilance after surgery. In the non-drain group, laparoscopic surgery was done routinely. The severity of abdominal and shoulder pain was measured with a visual scale of pain at 3, 6, 12, and 24 h after surgery. RESULTS There were no significant differences in age, type of surgery, duration of hospitalization, postoperative nausea and vomiting between the groups after surgery. The severity of shoulder pain was significant between groups 3, 6, 12, and 24 h after surgery (p < 0.001). Consumption of diclofenac after operation was higher in the control group (p < 0.001). The pain level of laparoscopic surgery was not different between the three groups within the first 24 h after surgery (p = 0.841). CONCLUSIONS The use of Hemovac drain in female laparoscopic surgery is beneficial for reducing the subsequent shoulder pain. Further studies are recommended to investigate the effects of deep breathing as a non-pharmacological and safe method in other laparoscopic areas.
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Affiliation(s)
- Fatemeh Hosseinzadeh
- Department of Anesthesiology and Operative Room, Mazandaran University of Medical Sciences, Allied medical sciences, Sari, Iran
| | - Ebrahim Nasiri
- Department of Anesthesiology, Faculty of Allied Medical Sciences, Traditional and Complementary Medicine Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Khazar Street, 48471-16548, Sari, Iran.
| | - Tahereh Behroozi
- Department of Obstetrics Surgery and Infertility, Reproductive Health Research Center, Urmia University of Medical Sciences, Urmia, Iran
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10
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Kumar R, Nath SS, Agarwal A. Intraperitoneal nebulization versus intraperitoneal instillation of ropivacaine for postoperative pain management following laparoscopic donor nephrectomy. Korean J Anesthesiol 2019; 72:357-365. [PMID: 30987415 PMCID: PMC6676037 DOI: 10.4097/kja.d.18.00290] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 04/03/2019] [Indexed: 11/10/2022] Open
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.
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Affiliation(s)
- Rajeev Kumar
- Department of Anesthesiology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Soumya Shankar Nath
- Department of Anesthesiology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anil Agarwal
- Department of Anesthesiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Grant MC, Gibbons MM, Ko CY, Wick EC, Cannesson M, Scott MJ, Wu CL. Evidence review conducted for the AHRQ Safety Program for Improving Surgical Care and Recovery: focus on anesthesiology for gynecologic surgery. Reg Anesth Pain Med 2019; 44:rapm-2018-100071. [PMID: 30737316 DOI: 10.1136/rapm-2018-100071] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 12/11/2018] [Accepted: 12/27/2018] [Indexed: 12/27/2022]
Abstract
Enhanced recovery after surgery (ERAS) protocols for gynecologic (GYN) surgery are increasingly being reported and may be associated with superior outcomes, reduced length of hospital stay, and cost savings. The Agency for Healthcare Research and Quality, in partnership with the American College of Surgeons and the Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, has developed the Safety Program for Improving Surgical Care and Recovery, which is a nationwide initiative to disseminate best practices in perioperative care to more than 750 hospitals across five major surgical service lines in a 5-year period. The program is designed to identify evidence-based process measures shown to prevent healthcare-associated conditions and hasten recovery after surgery, integrate those into a comprehensive service line-based pathway, and assist hospitals in program implementation. In conjunction with this effort, we have conducted an evidence review of the various anesthesia components which may influence outcomes and facilitate recovery after GYN surgery. A literature search was performed for each intervention, and the highest levels of available evidence were considered. Anesthesiology-related interventions for preoperative (carbohydrate loading/fasting, multimodal preanesthetic medications), intraoperative (standardized intraoperative pathway, regional anesthesia, protective ventilation strategies, fluid minimization) and postoperative (multimodal analgesia) phases of care are included. We have summarized the best available evidence to recommend the anesthetic components of care for ERAS for GYN surgery.
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Affiliation(s)
- Michael Conrad Grant
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital and Health System, Baltimore, Maryland, USA
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins Hospital and Health System, Baltimore, Maryland, USA
| | - Melinda M Gibbons
- Department of Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Clifford Y Ko
- Department of Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Elizabeth C Wick
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins Hospital and Health System, Baltimore, Maryland, USA
| | - Maxime Cannesson
- Department of Anesthesiology and Perioperative Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Michael J Scott
- Department of Anesthesiology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
- Department of Anesthesiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Christopher L Wu
- Anesthesiology, Hospital for Special Surgery, New York City, New York, USA
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Kwack JY, Ahn KH, Kwon Y. Postoperative pain control with ropivacaine following laparoscopic myomectomy: A randomized double‐blind, pilot study. J Obstet Gynaecol Res 2019; 45:871-876. [DOI: 10.1111/jog.13910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 12/08/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Jae Young Kwack
- Department of Obstetrics and GynaecologyNowon Eulji Medical Center, Eulji University Seoul South Korea
| | - Kwang Hee Ahn
- Department of Obstetrics and GynaecologyNowon Eulji Medical Center, Eulji University Seoul South Korea
| | - Yong‐Soon Kwon
- Department of Obstetrics and GynaecologyNowon Eulji Medical Center, Eulji University Seoul South Korea
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Immediate postoperative pain control with ropivacaine following laparoscopic-assisted vaginal hysterectomy: A randomized double-blind pilot study. Taiwan J Obstet Gynecol 2018; 57:654-658. [DOI: 10.1016/j.tjog.2018.08.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2018] [Indexed: 11/18/2022] Open
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14
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15
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Does Peritoneal Suction Drainage Reduce Pain After Gynecologic Laparoscopy? Surg Laparosc Endosc Percutan Tech 2018; 28:73-76. [DOI: 10.1097/sle.0000000000000490] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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16
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Essential Elements of Multimodal Analgesia in Enhanced Recovery After Surgery (ERAS) Guidelines. Anesthesiol Clin 2017; 35:e115-e143. [PMID: 28526156 DOI: 10.1016/j.anclin.2017.01.018] [Citation(s) in RCA: 238] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Perioperative multimodal analgesia uses combinations of analgesic medications that act on different sites and pathways in an additive or synergistic manner to achieve pain relief with minimal or no opiate consumption. Although all medications have side effects, opiates have particularly concerning, multisystemic, long-term, and short-term side effects, which increase morbidity and prolong admissions. Enhanced recovery is a systematic process addressing each aspect affecting recovery. This article outlines the evidence base forming the current multimodal analgesia recommendations made by the Enhanced Recovery After Surgery Society (ERAS). We describe current evidence and important future directions for effective perioperative multimodal analgesia in enhanced recovery pathways.
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Evaluation of ultrasound-guided posterior quadratus lumborum block for postoperative analgesia after laparoscopic gynecologic surgery. J Clin Anesth 2017; 41:1-4. [DOI: 10.1016/j.jclinane.2017.05.015] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 05/09/2017] [Accepted: 05/28/2017] [Indexed: 11/18/2022]
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18
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Asgari Z, Rezaeinejad M, Hosseini R, Nataj M, Razavi M, Sepidarkish M. Spinal Anesthesia and Spinal Anesthesia with Subdiaphragmatic Lidocaine in Shoulder Pain Reduction for Gynecological Laparoscopic Surgery: A Randomized Clinical Trial. Pain Res Manag 2017; 2017:1721460. [PMID: 28932131 PMCID: PMC5591920 DOI: 10.1155/2017/1721460] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 06/20/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of this study was to compare the effectiveness of spinal anesthesia with subdiaphragmatic lidocaine at the beginning of surgery versus spinal anesthesia in pain reduction for gynecological laparoscopic surgery. METHODS This was a clinical trial conducted in Arash Hospital, Tehran, Iran. Eighty-four patients were randomized to either spinal anesthesia with subdiaphragmatic lidocaine, spinal anesthesia, or general anesthesia (GA). The primary outcome was patients' pain perception during surgery, 2, 4, 6, and 12 hours after surgery, and prior to discharge and was assessed by visual analogue scale (VAS). RESULTS The results showed that there are no significant changes in pain perception over time in none of the three groups (F(4,76) = 0.37, P = 0.82). The severity of pain experienced by patients at all-time interval after surgery was similar between groups [F(2,79) = 0.54, P = 0.58]. CONCLUSION The use of subdiaphragmatic lidocaine at the beginning of surgery combined with spinal anesthesia was not associated with a statistically significant difference in patients' postoperative VAS scores compared to spinal anesthesia and GA during and after gynecological surgical procedures. The study was registered in Iranian Registry of Clinical Trial by the number of IRCT2016022226698N1.
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Affiliation(s)
- Zahra Asgari
- Department of Obstetrics and Gynecology, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahroo Rezaeinejad
- Department of Obstetrics and Gynecology, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Reihaneh Hosseini
- Department of Obstetrics and Gynecology, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoumeh Nataj
- Department of Obstetrics and Gynecology, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Razavi
- Department of Obstetrics and Gynecology, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Sepidarkish
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
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Effect of preemptive ketamine administration on postoperative visceral pain after gynecological laparoscopic surgery. ACTA ACUST UNITED AC 2016; 36:584-587. [PMID: 27465337 DOI: 10.1007/s11596-016-1629-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 06/20/2016] [Indexed: 10/21/2022]
Abstract
The pain following gynecological laparoscopic surgery is less intense than that following open surgery; however, patients often experience visceral pain after the former surgery. The aim of this study was to determine the effects of preemptive ketamine on visceral pain in patients undergoing gynecological laparoscopic surgery. Ninety patients undergoing gynecological laparoscopic surgery were randomly assigned to one of three groups. Group 1 received placebo. Group 2 was intravenously injected with preincisional saline and local infiltration with 20 mL ropivacaine (4 mg/mL) at the end of surgery. Group 3 was intravenously injected with preincisional ketamine (0.3 mg/kg) and local infiltration with 20 mL ropivacaine (4 mg/mL) at the end of surgery. A standard anesthetic was used for all patients, and meperidine was used for postoperative analgesia. The visual analogue scale (VAS) scores for incisional and visceral pain at 2, 6, 12, and 24 h, cumulative analgesic consumption and time until first analgesic medication request, and adverse effects were recorded postoperatively. The VAS scores of visceral pain in group 3 were significantly lower than those in group 2 and group 1 at 2 h and 6 h postoperatively (P<0.05 and P<0.01, respectively). At 2 h and 6 h, the VAS scores of incisional pain did not differ significantly between groups 2 and 3, but they were significantly lower than those in group 1 (P<0.01). Groups 1 and 2 did not show any differences in visceral pain scores at 2 h and 6 h postoperatively. Moreover, the three groups showed no statistically significant differences in visceral and incisional pain scores at 12 h and 24 h postoperatively. The consumption of analgesics was significantly greater in group 1 than in groups 2 and 3, and the time to first request for analgesics was significantly longer in groups 2 and 3 than in group 1, with no statistically significant difference between groups 2 and 3. However, the three groups showed no significant difference in the incidence of shoulder pain or adverse effects. Preemptive ketamine may reduce visceral pain in patients undergoing gynecological laparoscopic surgery.
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Saccardi C, Gizzo S, Vitagliano A, Noventa M, Micaglio M, Parotto M, Fiorese M, Litta P. Peri-incisional and intraperitoneal ropivacaine administration: a new effective tool in pain control after laparoscopic surgery in gynecology: a randomized controlled clinical trial. Surg Endosc 2016; 30:5310-5318. [DOI: 10.1007/s00464-016-4881-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 03/14/2016] [Indexed: 01/10/2023]
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21
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Guidelines for postoperative care in gynecologic/oncology surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations--Part II. Gynecol Oncol 2016; 140:323-32. [PMID: 26757238 PMCID: PMC6038804 DOI: 10.1016/j.ygyno.2015.12.019] [Citation(s) in RCA: 273] [Impact Index Per Article: 34.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 12/14/2015] [Accepted: 12/21/2015] [Indexed: 12/15/2022]
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22
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Collins GG, Gadzinski JA, Fitzgerald GD, Sheran J, Wagner S, Edelstein S, Mueller ER. Surgical Pain Control With Ropivacaine by Atomized Delivery (Spray): A Randomized Controlled Trial. J Minim Invasive Gynecol 2016; 23:40-5. [DOI: 10.1016/j.jmig.2015.07.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 07/23/2015] [Accepted: 07/24/2015] [Indexed: 11/25/2022]
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23
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Scalia Catenacci S, Lovisari F, Peng S, Allegri M, Somaini M, Ghislanzoni L, Greco M, Rossini V, D'Andrea L, Buda A, Signorelli M, Pellegrino A, Sportiello D, Bugada D, Ingelmo PM. Postoperative Analgesia after Laparoscopic Ovarian Cyst Resection: Double-blind Multicenter Randomized Control Trial Comparing Intraperitoneal Nebulization and Peritoneal Instillation of Ropivacaine. J Minim Invasive Gynecol 2015; 22:759-66. [PMID: 25820113 DOI: 10.1016/j.jmig.2015.01.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 01/20/2015] [Accepted: 01/27/2015] [Indexed: 01/22/2023]
Abstract
STUDY OBJECTIVE To compare the effects of local anesthetic intraperitoneal nebulization with intraperitoneal instillation during laparoscopic ovarian cystectomy on postoperative morphine consumption and pain. DESIGN Multicenter, randomized, case-control trial. DESIGN CLASSIFICATION Canadian Task Force Classification I. SETTING University hospitals in Italy. PATIENTS One hundred forty patients scheduled for laparoscopic ovarian cystectomy. INTERVENTIONS Patients were randomized to receive either nebulization of ropivacaine 150 mg before surgery or instillation of ropivacaine 150 mg before surgery. Nebulization was performed using the Aeroneb Pro device (Aerogen, Galway, Ireland). MEASUREMENTS AND MAIN RESULTS One hundred forty patients were enrolled, and 123 completed the study. There was no difference between the 2 groups in average morphine consumption (7.3 ± 7.5 mg in the nebulization group vs 9.2 ± 7.2 mg in the instillation group; p = .17). Eighty-two percent of patients in the nebulization group required morphine compared with 96% in the instillation group (p < .05). Patients receiving nebulization had a lower dynamic Numeric Ranking Scale compared with those in the instillation group in the postanesthesia care unit postanesthesia care unit and 4 hours after surgery (p < .05). Ten patients (15%) in the nebulization group experienced shivering in the postanesthesia care unit compared with 2 patients (4%) in the instillation group (p = .035). CONCLUSION Nebulization of ropivacaine prevents the use of morphine in a significant proportion of patients, reduced postoperative pain during the first hours after surgery, and was associated with a higher incidence of postoperative shivering when compared with instillation.
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Affiliation(s)
- Stefano Scalia Catenacci
- U.O. Anestesia e Rianimazione, Ospedale San Gerardo di Monza, Università di Milano-Bicocca, Milan, Italy
| | - Federica Lovisari
- U.O. Anestesia e Rianimazione, Ospedale San Gerardo di Monza, Università di Milano-Bicocca, Milan, Italy
| | - Shuo Peng
- McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Massimo Allegri
- Anesthesia and Pain Unit, Department of Surgical Science, Azienda Ospedaliera, University of Parma, Parma, Italy; Anesthesia Intensive Care and Pain Therapy Service, Azienda Ospedaliera, University of Parma, Parma, Italy
| | - Marta Somaini
- U.O. Anestesia e Rianimazione I, Ospedale Niguarda Ca' Granda, Università di Milano-Bicocca, Milan, Italy
| | - Luca Ghislanzoni
- U.O. Anestesia e Rianimazione, Ospedale San Gerardo di Monza, Università di Milano-Bicocca, Milan, Italy
| | - Massimiliano Greco
- U.O. Anestesia e Rianimazione 2, Dipartimento Neuroscienze, Azienda Ospedaliera Ospedale di Lecco, Italy
| | | | - Luca D'Andrea
- U.O. Anestesia e Rianimazione, Ospedale San Gerardo di Monza, Università di Milano-Bicocca, Milan, Italy
| | - Alessandro Buda
- U.O. Ginecologia e Ostetricia, Ospedale San Gerardo, Monza, Italy
| | - Mauro Signorelli
- U.O. Ginecologia e Ostetricia, Ospedale San Gerardo, Monza, Italy
| | - Antonio Pellegrino
- U.O. Ostetricia e Ginecologia, Azienda Ospedaliera Ospedale di Lecco, Italy
| | - Debora Sportiello
- Department of Anesthesia and Intensive Care, IRCCS Foundation, Policlinico San Matteo, Pavia, Italy
| | - Dario Bugada
- Department of Anesthesia and Intensive Care, IRCCS Foundation, Policlinico San Matteo, Pavia, Italy
| | - Pablo M Ingelmo
- McGill University Health Centre, McGill University, Montreal, Quebec, Canada; Montreal Children's Hospital and Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec, Canada.
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Jiménez Cruz J, Diebolder H, Dogan A, Mothes A, Rengsberger M, Hartmann M, Meissner W, Runnebaum IB. Combination of pre-emptive port-site and intraoperative intraperitoneal ropivacaine for reduction of postoperative pain: a prospective cohort study. Eur J Obstet Gynecol Reprod Biol 2014; 179:11-6. [DOI: 10.1016/j.ejogrb.2014.05.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Revised: 04/27/2014] [Accepted: 05/02/2014] [Indexed: 10/25/2022]
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The use of a peritoneal gas drain following gynecological laparoscopy: a systematic review. Eur J Obstet Gynecol Reprod Biol 2014; 179:224-8. [PMID: 24768233 DOI: 10.1016/j.ejogrb.2014.04.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 04/02/2014] [Accepted: 04/08/2014] [Indexed: 11/23/2022]
Abstract
We performed a systematic review of the randomized controlled trials (RCTs) reporting on the use of a peritoneal gas drain following gynecological laparoscopy. The standard medical databases were searched for studies published prior to with no restrictions for language, country of origin, blinding or sample size. We defined the primary endpoints: shoulder and total pain at 4-6, 24 and 48h following laparoscopy and secondary endpoints: women satisfaction, requirement of analgesia and antiemetics. The quality of the included RCTs was assessed by the guideline of the Cochrane Collaboration. Based on the data from 5 moderate quality RCTs we concluded that there is very little evidence of an overall benefit from using a peritoneal gas drain following gynecological laparoscopy The possible reduction of shoulder and total pain is not associated with a reduction in the requirement of analgesia and antiemetics when compared to the control group.
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Effects of peritoneal ropivacaine nebulization for pain control after laparoscopic gynecologic surgery. J Minim Invasive Gynecol 2014; 21:863-9. [PMID: 24727030 DOI: 10.1016/j.jmig.2014.03.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 03/24/2014] [Accepted: 03/25/2014] [Indexed: 11/21/2022]
Abstract
STUDY OBJECTIVE To evaluate the effects of peritoneal cold nebulization of ropivacaine on pain control after gynecologic laparoscopy. DESIGN Evidence obtained from a properly designed, randomized, double-blind, placebo-controlled trial (Canadian Task Force classification I). SETTING Tertiary care center. PATIENTS One hundred thirty-five women with American Society of Anesthesiologists disease classified as ASA I-III who were scheduled to undergo operative laparoscopy. INTERVENTION Patients were randomized to receive either nebulization of 30 mg ropivacaine before surgery (preoperative group), nebulization of 30 mg ropivacaine after surgery (postoperative group), instillation of 100 mg ropivacaine before surgery (instillation group), or instillation of saline solution (control group). Nebulization was performed using the Aeroneb Pro device. MEASUREMENT AND MAIN RESULTS Pain scores, morphine consumption, and ambulation time were collected in the post-anesthesia care unit and at 4, 6, and 24 hours postoperatively. One hundred eighteen patients completed the study. Patients in the preoperative group reported lower pain Numeric Ranking Scale values compared with those in the control group (net difference 2 points; 95% confidence interval [CI], 0.3-3.1 at 4 hours, 1-3 at 6 hours, and 0.7-3 at 24 hours; p = .01) Patients in the preoperative group consumed significantly less morphine than did those in the control group (net difference 7 mg; 95% CI, 0.7-13; p = .02). More patients who received nebulization walked without assistance within 12 hours after awakening than did those in the instillation and control groups (net difference 15%; 95% CI, 6%-24%; p = .001). CONCLUSIONS Cold nebulization of ropivacaine before surgery reduced postoperative pain and morphine consumption and was associated with earlier walking without assistance.
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Taş B, Donatsky AM, Gögenur I. Techniques to reduce shoulder pain after laparoscopic surgery for benign gynaecological disease: a systematic review. ACTA ACUST UNITED AC 2013. [DOI: 10.1007/s10397-013-0791-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Marks JL, Ata B, Tulandi T. Systematic review and metaanalysis of intraperitoneal instillation of local anesthetics for reduction of pain after gynecologic laparoscopy. J Minim Invasive Gynecol 2012; 19:545-53. [PMID: 22763313 DOI: 10.1016/j.jmig.2012.04.002] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 03/28/2012] [Accepted: 04/05/2012] [Indexed: 11/17/2022]
Abstract
We reviewed the effectiveness of intraperitoneal instillation of local anesthetic on pain after gynecologic laparoscopic surgery. Sources included the Cochrane Central Register of Controlled Trials, MEDLINE/PubMed, EMBASE, and Ovid MEDLINE In-Process & Other Non-Indexed Citations databases, and abstracts, reference lists, and randomized controlled trial (RCT) registries. The 7 included RCTs compared pain scores after administration of intraperitoneal analgesics or placebo/control during gynecologic laparoscopic surgery with benign indications. Outcome measures were pain scores (per visual analog scale) at 1 to 2, 4 to 6, and 24 hours postoperatively. Pain scores were significantly lower in the groups receiving local anesthesia at 1 to 2 hours (weighted mean difference [WMD], -1.82; 95% confidence interval [CI], -2.55 to -1.08]) and 4 to 6 hours postoperatively (WMD, -2.00; 95% CI, -3.64 to -0.35), but were similar at 24 hours (WMD, -1.43; 95% CI, -1.15 to 0.96). Local analgesia instilled intraperitoneally significantly decreased pain during a 6-hour interval after gynecologic laparoscopy.
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Affiliation(s)
- Jennifer L Marks
- Department of Obstetrics and Gynaecology, University of Western Ontario, London, Ontario, Canada.
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Intraperitoneal and intravenous lidocaine for effective pain relief after laparoscopic appendectomy: a prospective, randomized, double-blind, placebo-controlled study. Surg Endosc 2011; 25:3183-90. [DOI: 10.1007/s00464-011-1684-3] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Accepted: 03/14/2011] [Indexed: 01/16/2023]
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30
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Current World Literature. Curr Opin Anaesthesiol 2009; 22:822-7. [DOI: 10.1097/aco.0b013e328333ec47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Current World Literature. Curr Opin Obstet Gynecol 2009; 21:353-63. [DOI: 10.1097/gco.0b013e32832f731f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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