Postoperative pain is less intense after laparoscopic than after open surgery. However, minimally invasive surgeryis not a a pain-free procedure. Many trials have been done in adults using intraperitoneal and/or incisionallocal anesthetic, but similar studies have not yet been reported in the literature in children.Aim: The aim of this study was to evaluate the analgesic effect of periportal infiltration and intraperitoneal instillationof ropivacaine in children undergoing laparoscopic surgery.Materials and Methods: Thirty patients who underwent laparoscopic surgery were randomly allocated to oneof three groups. Group A (n 10) received local infiltration of port sites with 10 mL of ropivacaine. Group B(n 10) received both an infiltration of port sites with 10 mL of ropivacaine and an intraperitoneal instillationof 10 mL of ropivacaine. Group C did not receive any analgesic treatment. The local anesthetic was always administeredat the end of surgery. The degree of postoperative abdominal parietal pain, abdominal visceral pain,and shoulder pain was assessed by using a Wong-Baker pain scale and a Visual Analog Scale (VAS) at 3, 6 12,and 24 hours postoperatively. The following parameters were also evaluated: rescue analgesic treatment, lengthof hospital stay, and time of return to normal activities.Results: Three hours after operation, patients had low pain scores. Six and 12 hours postoperatively, the abdominalparietal pain was significantly higher (P 0.0005) in group C than in the other two groups, both treatedwith an infiltration at the trocar sites; mean intensity of abdominal visceral pain was significantly lower (P 0.0005) in group B than in groups A and C; the overall incidence of shoulder pain was significantly lower (P 0.0005) in group B patients than in patients of groups A and C. At 20 hours postoperatively, pain scores weresignificantly reduced of intensity in all groups. Rescue analgesic treatment was significantly higher in groupC, if compared to groups A and B 12 hours after the operation. No statistically significant difference was foundin length of hospital stay, but children who received analgesic treatment had a more rapid return to normalactivities than untreated patients (P 0.0005).Conclusions: Our study demonstrates that the combination of local infiltration and intraperitoneal instillationof ropivacaine is more effective for pain relief in children after laparoscopic surgery than the administration ofropivacaine only at the trocar sites.
|Numero di pagine||5|
|Rivista||JOURNAL OF LAPAROENDOSCOPIC & ADVANCED SURGICAL TECHNIQUES|
|Stato di pubblicazione||Published - 2009|
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