[Multimodal analgesia in elective laparoscopic cholecystectomy. A double-blind randomized controlled trial].

BACKGROUND: The aim of this study was to test the effects of preincisional parietal and intraperitoneal infiltration with ropivacaine (R) on postoperative pain after elective laparoscopic cholecystectomy.

METHODS: 60 patients scheduled for laparoscopic cholecystectomy performed by the same surgeon were enrolled in a randomized, controlled double-blind trial. All patients received the same general anesthesia protocol and Ig i.v. paracetamol was infused after induction of anesthesia for postoperative analgesia, repeated postoperatively each 6 hours, up to 4 g/ 24 h. After induction of anesthesia, the patients were randomized in 4 groups (15 patients each): group A received preincisional parietal infiltration of 20 ml normal saline (NS) solution and 20 ml R0, 25% intraperitoneal instillation; group B, 20 ml R0, 0.25% preincisional parietal and 20 ml NS intraperitoneal; group C, 20 ml R0, 25% preincisional parietal and 20 ml R0, 25% intraperitoneal; group D (control), 20 ml NS preincisional local and 20 ml NS intraperitoneal. Tramadol was used as a rescue analgesic Primary end points: were postoperative pain at Oh, 2h, 6h, 12h, 24h on visual analogue scale (VAS 0-100 mm) score and rescue analgesic requirements.

RESULTS: We found no differences in demographics, length of surgery time and hospital stay (total 3.38 +/- 0.22 days). VAS was significantly lower at all intervals in groups C versus D and at Oh, 6h and 12 h in group C versus group A and B (p < 0.05). We found no influence on shoulder pain. Tramadol doses required were significantly lower in group C vs. D (0,73 +/- 1.10 vs 1,93 +/- 1.03, p = 0.017).

CONCLUSION: Ropivacaine shows significant favorable effects on postoperative pain after laparoscopic cholecystectomy when using both parietal and intraperitoneal instillation in combination with perioperative i.v. paracetamol.