Clinical Trials Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 14, 2019; 25(34): 5185-5196
Published online Sep 14, 2019. doi: 10.3748/wjg.v25.i34.5185
Overlay of a sponge soaked with ropivacaine and multisite infiltration analgesia result in faster recovery after laparoscopic hepatectomy
Hao Zhang, Gang Du, Yan-Feng Liu, Jin-Huan Yang, Mu-Guo A-Niu, Xiang-Yu Zhai, Bin Jin
Hao Zhang, Gang Du, Yan-Feng Liu, Jin-Huan Yang, Mu-Guo A-Niu, Xiang-Yu Zhai, Bin Jin, Department of General Surgery, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China
Author contributions: Zhang H and Du G collected the data and drafted the manuscript; A-Niu MG, Liu YF, and Zhai XY contributed to data collection and statistical analysis; Yang JH helped revise the manuscript; Jin B contributed to the study design and revised the manuscript; all authors read and approved the final manuscript.
Supported by the National Natural Science Foundation of China, No. 81571367; and Technological Project of Shandong Province, No. 2017GSF218021.
Institutional review board statement: This study was approved by the Medical Ethics Committee of Qilu Hospital of Shandong University (No. 2017052).
Clinical trial registration statement: This study is registered at []. The registration identification number is [ChiCTR1900020630].
Informed consent statement: All involved patients provided informed consent prior to the study inclusion.
Conflict-of-interest statement: We declare that we have no conflicts of interest.
Data sharing statement: This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Bin Jin, MD, PhD, Chief Doctor, Professor, Surgeon, Department of general Surgery, Qilu Hospital of Shandong University, 107 Wenhua Xi Road, Lixia, Jinan 250012, Shandong Province, China.
Telephone: +86-18366116329
Received: May 17, 2019
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
Research background

The postoperative pain caused by laparoscopic hepatectomy delays patients’ recovery, although the pain has reduced a lot compared with laparotomy. Although many methods have been reported for pain relief including intravenous analgesia, epidural analgesia and so on, these methods have their limitations and contraindications. Local wound infiltration is a simple and safe method that can effectively relieve the pain after surgery. The current study was designed to evaluate the effects of ropivacaine on pain control after laparoscopic hepatectomy and to examine whether this local anesthetic technique accelerates patient recovery, thus contributing to the idea of fast track recovery surgery.

Research motivation

Many methods have been reported 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 find an effective and convenient method which can be can be clinically adopted to decrease postoperative pain and accelerate recovery.

Research objectives

The aim of the study was to assess the effectiveness of ropivacaine injections in the port site as well as in the operative site in patients undergoing a hepatectomy.

Research methods

Before the start of the study, random sequence was generated to make sure that the allocation was completely random. For allocation concealment, envelope method was adopted. Continuous data were analyzed by t-tests. The P-value and 95% confidence interval were calculated. Categorical data were analyzed by chi-square tests. All data were checked for normal distribution. Double blindness was ensured, and the researcher in charge of allocation and anesthetic preparation did not participate in the data collection and analysis.

Research results

Infiltration with ropivacaine in the abdominal wound and covering the cutting surface of the liver with a gelatin sponge soaked with ropivacaine could provide effective analgesia after laparoscopic hepatectomy, with a lower visual analog scale (VAS) score and sufentanil consumption, accelerated postoperative recovery, and reduced stress response. These results suggest that this method is a simple, convenient, and effective analgesic method that can provide postoperative analgesia and short-term benefits after surgery. There are still problems need to be solved: The best concentration and dose used for local anesthesia need more research to determine, and more effective anesthetics and better method of application need to be found.

Research conclusions

This study provides evidence supporting that infiltration with ropivacaine in the abdominal wound and covering the cutting surface of the liver with a gelatin sponge soaked with ropivacaine after laparoscopic hepatectomy can improve postoperative pain relief, reduce surgical stress response, and accelerate postoperative recovery. This method is very worthy of application and promotion for its simplicity, safety and efficacy.

Research perspectives

In this study, the effect of pain relief of ropivacaine remained no more than 24 h to 48 h, so anesthetics with a more lasting effect need to be found. Furthermore, more research is needed to determine the best concentration and dose used for local anesthesia. Methods of anesthetics application are variable, so researchers could try to find more effective and convenient techniques for pain relief.