Stefano Scalia Catenacci1, Federica Lovisari1, Shuo Peng2, Massimo Allegri3, Marta Somaini4, Luca Ghislanzoni1, Massimiliano Greco5, Valeria Rossini6, Luca D'Andrea1, Alessandro Buda7, Mauro Signorelli7, Antonio Pellegrino8, Debora Sportiello9, Dario Bugada9, Pablo M Ingelmo10. 1. U.O. Anestesia e Rianimazione, Ospedale San Gerardo di Monza, Università di Milano-Bicocca, Milan, Italy. 2. McGill University Health Centre, McGill University, Montreal, Quebec, Canada. 3. Anesthesia and Pain Unit, Department of Surgical Science, Azienda Ospedaliera, University of Parma, Parma, Italy; Anesthesia Intensive Care and Pain Therapy Service, Azienda Ospedaliera, University of Parma, Parma, Italy. 4. U.O. Anestesia e Rianimazione I, Ospedale Niguarda Ca' Granda, Università di Milano-Bicocca, Milan, Italy. 5. U.O. Anestesia e Rianimazione 2, Dipartimento Neuroscienze, Azienda Ospedaliera Ospedale di Lecco, Italy. 6. Università di Milano-Bicocca, Milan, Italy. 7. U.O. Ginecologia e Ostetricia, Ospedale San Gerardo, Monza, Italy. 8. U.O. Ostetricia e Ginecologia, Azienda Ospedaliera Ospedale di Lecco, Italy. 9. Department of Anesthesia and Intensive Care, IRCCS Foundation, Policlinico San Matteo, Pavia, Italy. 10. McGill University Health Centre, McGill University, Montreal, Quebec, Canada; Montreal Children's Hospital and Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec, Canada. Electronic address: pablo.ingelmo@mcgill.ca.
Abstract
STUDY OBJECTIVE: To compare the effects of local anesthetic intraperitoneal nebulization with intraperitoneal instillation during laparoscopic ovarian cystectomy on postoperative morphine consumption and pain. DESIGN: Multicenter, randomized, case-control trial. DESIGN CLASSIFICATION: Canadian Task Force Classification I. SETTING: University hospitals in Italy. PATIENTS: One hundred forty patients scheduled for laparoscopic ovarian cystectomy. INTERVENTIONS: Patients were randomized to receive either nebulization of ropivacaine 150 mg before surgery or instillation of ropivacaine 150 mg before surgery. Nebulization was performed using the Aeroneb Pro device (Aerogen, Galway, Ireland). MEASUREMENTS AND MAIN RESULTS:One hundred forty patients were enrolled, and 123 completed the study. There was no difference between the 2 groups in average morphine consumption (7.3 ± 7.5 mg in the nebulization group vs 9.2 ± 7.2 mg in the instillation group; p = .17). Eighty-two percent of patients in the nebulization group required morphine compared with 96% in the instillation group (p < .05). Patients receiving nebulization had a lower dynamic Numeric Ranking Scale compared with those in the instillation group in the postanesthesia care unit postanesthesia care unit and 4 hours after surgery (p < .05). Ten patients (15%) in the nebulization group experienced shivering in the postanesthesia care unit compared with 2 patients (4%) in the instillation group (p = .035). CONCLUSION: Nebulization of ropivacaine prevents the use of morphine in a significant proportion of patients, reduced postoperative pain during the first hours after surgery, and was associated with a higher incidence of postoperative shivering when compared with instillation.
RCT Entities:
STUDY OBJECTIVE: To compare the effects of local anesthetic intraperitoneal nebulization with intraperitoneal instillation during laparoscopic ovarian cystectomy on postoperative morphine consumption and pain. DESIGN: Multicenter, randomized, case-control trial. DESIGN CLASSIFICATION: Canadian Task Force Classification I. SETTING: University hospitals in Italy. PATIENTS: One hundred forty patients scheduled for laparoscopic ovarian cystectomy. INTERVENTIONS:Patients were randomized to receive either nebulization of ropivacaine 150 mg before surgery or instillation of ropivacaine 150 mg before surgery. Nebulization was performed using the Aeroneb Pro device (Aerogen, Galway, Ireland). MEASUREMENTS AND MAIN RESULTS: One hundred forty patients were enrolled, and 123 completed the study. There was no difference between the 2 groups in average morphine consumption (7.3 ± 7.5 mg in the nebulization group vs 9.2 ± 7.2 mg in the instillation group; p = .17). Eighty-two percent of patients in the nebulization group required morphine compared with 96% in the instillation group (p < .05). Patients receiving nebulization had a lower dynamic Numeric Ranking Scale compared with those in the instillation group in the postanesthesia care unit postanesthesia care unit and 4 hours after surgery (p < .05). Ten patients (15%) in the nebulization group experienced shivering in the postanesthesia care unit compared with 2 patients (4%) in the instillation group (p = .035). CONCLUSION: Nebulization of ropivacaine prevents the use of morphine in a significant proportion of patients, reduced postoperative pain during the first hours after surgery, and was associated with a higher incidence of postoperative shivering when compared with instillation.