Early intraperitoneal ropivacaine for acute pain relief after ambulatory laparoscopic cholecystectomy: a randomized controlled trial.

BACKGROUND

Intraperitoneal local anesthetic may reduce early postoperative pain after laparoscopic surgery, but evidence in ambulatory settings is inconsistent.

METHODS

Prospective, randomized, double-blind, placebo-controlled trial including 113 adults undergoing ambulatory laparoscopic cholecystectomy. After pneumoperitoneum and before surgical manipulation, patients received 20 mL 0.25% ropivacaine or saline intraperitoneally. Primary outcomes - VAS pain at 0, 4, 6, 12 h and opioid use in the recovery room. Pain was analyzed with a linear mixed-effects model. Chronic pain was assessed at three and six months.

RESULTS

Ropivacaine lowered VAS at 0 h (3.1±2.4 vs. 5.1±2.6), 4 h (1.5±1.8 vs. 2.8±2.3) and 6 h (1.7±1.7 vs. 3.5±2.6; all P<0.001). Group×time interaction was significant (P=0.008). Opioid consumption was reduced (mean difference -3.3 mg piritramide; 95% CI -5.0 to -1.6; P<0.001). No difference at 12 h or in chronic pain at three-six months; no serious adverse events.

CONCLUSIONS

Early intraperitoneal ropivacaine improves immediate postoperative analgesia and reduces opioids after ambulatory laparoscopic cholecystectomy. It is a simple, safe adjunct to multimodal analgesia.