Consider intraperitoneal ropivacaine for colectomy ERAS

 

SEATTLE – Intraperitoneal ropivacaine decreases postoperative pain and improves functional recovery after laparoscopic colectomy, according to randomized, blinded trial from the Royal Adelaide (Australia) Hospital.

“We recommend routine inclusion of IPLA [intraperitoneal local anesthetic] in the multimodal analgesia component of ERAS [enhanced-recovery-after-surgery] programs for laparoscopic colectomy,” the investigators concluded.

IPLA has been demonstrated before to reduce postoperative pain and nausea following open colectomy. “We wanted to determine the effect in our everyday practice following laparoscopic bowel resection,” senior investigator Mark Lewis, MBBS, a consultant colorectal surgeon at the hospital, said at the American Society of Colon and Rectal surgeons annual meeting (Ann Surg. 2011 Jul;254[1]:28-38). The subjects were adults undergoing elective procedures; 26 were randomized to instillation of a 100 mg intraperitoneal ropivacaine solution throughout the abdomen – both before dissection and prior to abdominal closure – and a continuous postoperative infusion of 20 mg/hour for 48 hours, delivered to the operative region of greatest dissection; 25 were randomized to a normal saline equivalent.

Recovery was smoother in the ropivacaine group. On a 90-point surgical recovery scale assessing fatigue, mental function, and the ability to do normal daily activities, ropivacaine patients were a few points ahead on days 1 and 3; the gap widened to about 10 points on days 7, 30, and 45. Ropivacaine might have helped reduced inflammation, accounting for the extended benefit, Dr. Lewis said.

Pain control was better with ropivacaine, as well. Ropivacaine patients were about 15-20 points lower on 50-point scales assessing both visceral and abdominal pain at postop hours 3 and 24, and day 7. The findings were statistically significant.

Several trends also favored ropivacaine. Ropivacaine patients had their first bowel movement at around 70 hours postop, versus about 82 hours in the control group. They were also discharged almost a day sooner, and had less postop vomiting. Just one patient in the ropivacaine group was diagnosed with ileus, versus four in the control arm.

There was also a trend for less opioid use in the ropivacaine group, which Dr. Lewis suspected would have been statistically significant if the trial had more patients.

Ropivacaine patients were a mean of 67 years old, versus 62 years old in the control group. There were slightly more men than women in each arm. The mean body mass index in the ropivacaine group was 28.5 kg/m², and in the control group 26.4 kg/m². Ropivacaine was discontinued in two patients due to possible toxicity.

An audience member noted that intravenous lidocaine has shown similar benefits in abdominal surgery.

The investigators had no disclosures.
 

[email protected]

 

SEATTLE – Intraperitoneal ropivacaine decreases postoperative pain and improves functional recovery after laparoscopic colectomy, according to randomized, blinded trial from the Royal Adelaide (Australia) Hospital.

“We recommend routine inclusion of IPLA [intraperitoneal local anesthetic] in the multimodal analgesia component of ERAS [enhanced-recovery-after-surgery] programs for laparoscopic colectomy,” the investigators concluded.

IPLA has been demonstrated before to reduce postoperative pain and nausea following open colectomy. “We wanted to determine the effect in our everyday practice following laparoscopic bowel resection,” senior investigator Mark Lewis, MBBS, a consultant colorectal surgeon at the hospital, said at the American Society of Colon and Rectal surgeons annual meeting (Ann Surg. 2011 Jul;254[1]:28-38). The subjects were adults undergoing elective procedures; 26 were randomized to instillation of a 100 mg intraperitoneal ropivacaine solution throughout the abdomen – both before dissection and prior to abdominal closure – and a continuous postoperative infusion of 20 mg/hour for 48 hours, delivered to the operative region of greatest dissection; 25 were randomized to a normal saline equivalent.

Recovery was smoother in the ropivacaine group. On a 90-point surgical recovery scale assessing fatigue, mental function, and the ability to do normal daily activities, ropivacaine patients were a few points ahead on days 1 and 3; the gap widened to about 10 points on days 7, 30, and 45. Ropivacaine might have helped reduced inflammation, accounting for the extended benefit, Dr. Lewis said.

Pain control was better with ropivacaine, as well. Ropivacaine patients were about 15-20 points lower on 50-point scales assessing both visceral and abdominal pain at postop hours 3 and 24, and day 7. The findings were statistically significant.

Several trends also favored ropivacaine. Ropivacaine patients had their first bowel movement at around 70 hours postop, versus about 82 hours in the control group. They were also discharged almost a day sooner, and had less postop vomiting. Just one patient in the ropivacaine group was diagnosed with ileus, versus four in the control arm.

There was also a trend for less opioid use in the ropivacaine group, which Dr. Lewis suspected would have been statistically significant if the trial had more patients.

Ropivacaine patients were a mean of 67 years old, versus 62 years old in the control group. There were slightly more men than women in each arm. The mean body mass index in the ropivacaine group was 28.5 kg/m², and in the control group 26.4 kg/m². Ropivacaine was discontinued in two patients due to possible toxicity.

An audience member noted that intravenous lidocaine has shown similar benefits in abdominal surgery.

The investigators had no disclosures.
 

[email protected]

 

SEATTLE – Intraperitoneal ropivacaine decreases postoperative pain and improves functional recovery after laparoscopic colectomy, according to randomized, blinded trial from the Royal Adelaide (Australia) Hospital.

“We recommend routine inclusion of IPLA [intraperitoneal local anesthetic] in the multimodal analgesia component of ERAS [enhanced-recovery-after-surgery] programs for laparoscopic colectomy,” the investigators concluded.

IPLA has been demonstrated before to reduce postoperative pain and nausea following open colectomy. “We wanted to determine the effect in our everyday practice following laparoscopic bowel resection,” senior investigator Mark Lewis, MBBS, a consultant colorectal surgeon at the hospital, said at the American Society of Colon and Rectal surgeons annual meeting (Ann Surg. 2011 Jul;254[1]:28-38). The subjects were adults undergoing elective procedures; 26 were randomized to instillation of a 100 mg intraperitoneal ropivacaine solution throughout the abdomen – both before dissection and prior to abdominal closure – and a continuous postoperative infusion of 20 mg/hour for 48 hours, delivered to the operative region of greatest dissection; 25 were randomized to a normal saline equivalent.

Recovery was smoother in the ropivacaine group. On a 90-point surgical recovery scale assessing fatigue, mental function, and the ability to do normal daily activities, ropivacaine patients were a few points ahead on days 1 and 3; the gap widened to about 10 points on days 7, 30, and 45. Ropivacaine might have helped reduced inflammation, accounting for the extended benefit, Dr. Lewis said.

Pain control was better with ropivacaine, as well. Ropivacaine patients were about 15-20 points lower on 50-point scales assessing both visceral and abdominal pain at postop hours 3 and 24, and day 7. The findings were statistically significant.

Several trends also favored ropivacaine. Ropivacaine patients had their first bowel movement at around 70 hours postop, versus about 82 hours in the control group. They were also discharged almost a day sooner, and had less postop vomiting. Just one patient in the ropivacaine group was diagnosed with ileus, versus four in the control arm.

There was also a trend for less opioid use in the ropivacaine group, which Dr. Lewis suspected would have been statistically significant if the trial had more patients.

Ropivacaine patients were a mean of 67 years old, versus 62 years old in the control group. There were slightly more men than women in each arm. The mean body mass index in the ropivacaine group was 28.5 kg/m², and in the control group 26.4 kg/m². Ropivacaine was discontinued in two patients due to possible toxicity.

An audience member noted that intravenous lidocaine has shown similar benefits in abdominal surgery.

The investigators had no disclosures.
 

[email protected]