Br J Anaesth
Department of Perioperative Medicine and Intensive Care, Institute of Physiology and Pharmacology, Karolinska University Hospital, Stockholm, Sweden.
Published: May 2020
Background: Advanced-stage ovarian cancer has a poor prognosis; surgical resection with the intent to leave no residual tumour followed by adjuvant chemotherapy is the standard treatment. Local anaesthetics (LA) have anti-inflammatory and analgesic effects. We hypothesised that intraperitoneal LA (IPLA) would lead to improved postoperative recovery, better pain relief, and earlier start of chemotherapy.
Methods: This was a prospective, randomised, double-blind, placebo-controlled pilot study in 40 women undergoing open abdominal cytoreductive surgery. Patients were randomised to receive either intraperitoneal ropivacaine (Group IPLA) or saline (Group Placebo) perioperatively. Except for study drug, patients were treated similarly. Intraoperatively, ropivacaine 2 mg ml or 0.9% saline was injected thrice intraperitoneally, and after operation via a catheter and analgesic pump into the peritoneal cavity for 72 h. Postoperative pain, time to recovery, home discharge, time to start of chemotherapy, and postoperative complications were recorded.
Results: No complications from LA administration were recorded. Pain intensity and rescue analgesic consumption were similar between groups. Time to initiation of chemotherapy was significantly shorter in Group IPLA (median 21 [inter-quartile range 21-29] vs 29 [inter-quartile range 21-40] days; P=0.021). Other parameters including time to home readiness, home discharge and incidence, and complexity of postoperative complications were similar between the groups.
Conclusions: Intraperitoneal ropivacaine during and for 72 h after operation after cytoreductive surgery for ovarian cancer is safe and reduces the time interval to initiation of chemotherapy. Larger studies are warranted to confirm these initial findings.
Clinical Trial Registration: NCT02256228.
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http://dx.doi.org/10.1016/j.bja.2020.01.026 | DOI Listing |
Cureus
November 2024
Anaesthesiology, Dr. D Y Patil Medical College, Hospital and Research Centre, Dr. D Y Patil Vidyapeeth, Pune, IND.
Introduction Laparoscopic cholecystectomy, despite its several advantages, is sometimes associated with discomfort due to pain in the immediate postoperative period. Effective management of this pain is critical for enhancing recovery, minimizing complications, and facilitating early discharge. The use of local anesthetics for intra-abdominal analgesia, specifically bupivacaine and ropivacaine, has been investigated as a means to improve postoperative pain control.
View Article and Find Full Text PDFBr J Anaesth
November 2024
Department of Women's and Children's Health, Division of Obstetrics and Gynaecology, Karolinska Institutet, Stockholm, Sweden, Department of Pelvic Cancer, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden.
Background: In a previous phase II trial, intraperitoneal local anaesthetics shortened the time interval between surgery and adjuvant chemotherapy, an endpoint associated with improved survival in advanced ovarian cancer. Our objective was to test this in a phase III trial.
Methods: A double-blind, phase III parallel superiority trial was conducted at two university hospitals in Sweden, within a public and centralised healthcare system.
BMC Anesthesiol
October 2024
Department of Anesthesiology, Aerospace Center Hospital, No. 15 Yuquan Road, Haidian District, Beijing, 100049, China.
Objective: Currently, the primary surgical treatment for pseudomyxoma peritonei (PMP) is cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC). The perioperative period is frequently accompanied by severe pain. Erector spinae plane block (ESPB) can enhance analgesia for abdominal surgery.
View Article and Find Full Text PDFMedicine (Baltimore)
July 2024
Department of Surgery, Universitäts Medizin Mannheim, Heidelberg University, Mannheim, Germany.
Background: Managing postoperative pain effectively with an opioid-free regimen following laparoscopic surgery (LS) remains a significant challenge. Intraperitoneal instillation of ropivacaine has been explored for its potential to reduce acute postoperative pain, but its efficacy and safety are still under debate. This study aimed to evaluate the efficacy and safety of intraperitoneal instillation of ropivacaine for acute pain management following laparoscopic digestive surgery.
View Article and Find Full Text PDFObes Surg
March 2024
Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, NO. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050, People's Republic of China.
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