GULHANE MEDICAL JOURNAL 2008 , Vol 50 , Issue 2
Multiregional local anesthesic administration for the prevention of postoperative pain after laparoscopic cholecystectomy: placebo controlled comparison of ropivacaine and prilocaine
Ceyhun Memedov1, Öner Menteş1, Abdurrahman Şimşek1, Can Kece1, Gökhan Yağcı1, Ali Harlak1, Ahmet Coşar2, Turgut Tufan1
1GATF Genel Cerrahi AD, Ankara
2GATF Anesteziyoloji ve Reanimasyon AD, Ankara
Although postoperative pain is less often seen in laparoscopic cholecystectomy when compared to conventional surgery, laparoscopic cholecystectomy is not a procedure completely free of pain. The postoperative analgesic effect of intraperitoneal local anesthetic administration during laparoscopic cholecystectomy is still controversial. This prospective randomized study was planned to investigate whether intraperitoneal and port sites administration of ropivacaine and prilocaine has beneficial effects on postoperative analgesia and pulmonary functions and to compare their effects. Forty five ASA I and II patients scheduled for elective laparoscopic cholecystectomy were included in the study. The patients were randomized into 3 groups to receive either a total of 150 mg (80 mL) ropivacaine or a mixture of 400 mg (20 mL) prilocaine (80 mL) or placebo (80 mL saline). Eighty ml were injected into gall bladder, right and left subdiaphragmatic areas and onto visceral periton, and 20 ml, 5 ml each, were injected into around the entry of 4 port sites. Visual analogue scale scores, tramadol consumption, nausea and vomiting, sedation status and SpO2 values were evaluated and recorded immediately at arrival in the postanesthesia care unit, and at 2, 4, 8, 12,18 and 24 h after the surgery. Visual analogue scale scores at rest and after coughing and tramadol consumption at 24 h were significantly lower in the ropivacaine group when compared to the placebo group (p<0.05). There were no ststistically significant differences between the prilocaine and placebo groups (p>0.05). In conclusion, the multiregional intraperitoneal instillation and port site infiltration of ropivacaine, a long acting local anesthetic, after laparoscopic cholecystectomy is a noninvasive, safe and simple technique that reduces the pain and postoperative tramadol consumption. The same effect was not observed with prilocaine administration. Keywords : Postoperative pain, laparoscopic cholecystectomy, prilocaine, ropivacaine