Published online Sep 14, 2019. doi: 10.3748/wjg.v25.i34.5185
Peer-review started: May 17, 2019
First decision: July 21, 2019
Revised: August 4, 2019
Accepted: August 19, 2019
Article in press: August 19, 2019
Published online: September 14, 2019
Compared with traditional open surgery, laparoscopic surgery is preferred due to the advantages of less trauma, less pain, and faster recovery. Nevertheless, many patients still suffer from postoperative pain resulting from the surgical incision and associated tissue injury. Many researchers have reported methods to improve postoperative pain control, but there is not a simple and effective method that can be clinically adopted in a widespread manner. We designed this study to prove the hypothesis that application of ropivacaine in the port site and operative site in patients is an effective and convenient method which can decrease postoperative pain and accelerate recovery.
To evaluate the effects of ropivacaine on pain control after laparoscopic hepatectomy and its contribution to patient recovery.
From May 2017 to November 2018, 146 patients undergoing laparoscopic hepatectomy were randomized to receive infiltration of either 7.5 mg/mL ropivacaine around the trocar insertions, incision, and cutting surface of the liver (with a gelatin sponge soaked with ropivacaine) at the end of surgery (ropivacaine group), or normal saline (5 mL) at the same sites at the end of surgery (control group). The degree of pain, nausea, vomiting, heart rate (HR), and blood pressure were collected. The length of postoperative hospitalization, complications, and the levels of stress hormones were also compared between the two groups.
Compared with the control group, the ropivacaine group showed reduced postoperative pain at rest within 12 h (P < 0.05), and pain on movement was reduced within 48 h. The levels of epinephrine, norepinephrine, and cortisol at 24 and 48 h, HR, blood pressure, and cumulative sufentanil consumption in the ropivacaine group were significantly lower than those in the control group (P < 0.05). In the ropivacaine group, hospitalization after operation was shorter, but the difference was not statistically significant. There were no significant differences in postoperative nausea, vomiting, or other complications, including hydrothorax, ascites, peritonitis, flatulence, and venous thrombus (P > 0.05), although fewer patients in the ropivacaine group experienced these situations.
Infiltration with ropivacaine in the abdominal wound and covering the cutting surface of the liver with a gelatin sponge soaked with ropivacaine significantly reduce postoperative pain and the consumption of sufentanil.
Core tip: This study confirmed the efficacy of ropivacaine in pain control after laparoscopic hepatectomy and its contribution to fast track recovery surgery. Ropivacaine not only infiltrated the subcutaneous and deep muscle fasciae and peritoneum but also covered the liver cutting surface in a soaked gelatin sponge to relieve the pain caused by capsule injury. We examined the efficacy using not only visual analog scale, but also blood biochemistry and other standards.