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
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.
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.
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.
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.
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.
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.
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.