Pre-emptive intraperitoneal local anaesthesia: an effective method in immediate post-operative pain management and metabolic stress response in laparoscopic appendicectomy, a randomized, double-blinded, placebo-controlled study

ANZ J Surg. 2012 Oct 11. doi: 10.1111/j.1445-2197.2012.06210.x. [Epub ahead of print]


Thanapal MR, Tata MD, Tan AJ, Subramaniam T, Tong JM, Palayan K, Rampal S, Gurunathan R.


Department of Surgery, Tuanku Ja'afar Hospital, Seremban, Negeri Sembilan, Malaysia; Department of Surgery, University of Malaya Medical Centre, Kuala Lumpur, Malaysia.


BACKGROUND: Although laparoscopic surgeries are associated with reduced surgical stress response and shortened post-operative recovery, intense pain and high analgesia requirements in the immediate post-operative period are often the chief complaints.

AIM: The aim of this study was to evaluate the effect of pre-emptive intraperitoneal local anaesthetic drugs on post-operative pain management and metabolic stress response in laparoscopic appendicectomy.

METHOD: The method used was a randomized double-blinded placebo-controlled study. Patients with clinical diagnosis of acute appendicitis who fulfil the criteria, were taken into this study. Primary outcomes investigated were consumption of patient-controlled analgesia during the immediate post-operative period (first 6 h) and subsequent 18 h as well as serum cortisol sampling.

RESULTS: Total of 120 patients were recruited into three different treatment groups (placebo, ropivacaine, levobupivacaine). In order to maintain visual analogue score of 0-1 during the immediate post-operative period, patients in the placebo group required significantly (P < 0.001) higher dose of analgesia (morphine/mg) - 11 mg (8.3-15.5) as compared with ropivacaine - 4 mg (3.0-6.0) and levobupivacaine - 3.5 mg (2.0-5.0). The immediate post-operative serum cortisol showed a significant increase in serum cortisol in the placebo group (P = 0.001) as compared with ropivacaine and levobupivacaine groups.

CONCLUSION: Pre-emptive intraperitoneal local anaesthesia in laparoscopy surgery is a safe, non-invasive procedure that can benefit patients by reducing the immediate post-operative pain intensity and metabolic stress response of the body.


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