6533b862fe1ef96bd12c60db

RESEARCH PRODUCT

Intraoperative wound instillation of ropivacaine extraperitoneally subfascially fails to provide analgesia after remifentanil–isoflurane for abdominal hysterectomy

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Summary Background Intraoperative local anaesthetic wound instillation has been shown previously to provide analgesia after abdominal surgery. This pain relief may be important, if remifentanil is used for general anaesthesia, because the rapid offset of action may mean that there is not enough analgesia at the end of surgery and in the recovery period. The aim of this randomized, placebo-controlled, double-blind study was to evaluate the analgesic efficacy of preventative wound instillation of ropivacaine after abdominal hysterectomy (AH). We hypothesized that this approach will significantly reduce postoperative morphine consumption. Patients and methods After ethics approval, 40 patients undergoing AH were included. Surgery was performed under general anaesthesia (remifentanil, isoflurane). After peritoneal closure in 20 patients 40 ml ropivacaine 0.75% was administered topically onto the peritoneum (placebo group, n = 20; 40 ml saline 0.9%). After 10 min, any remaining liquid was suctioned and complete wound closure performed. Primary outcome variable was opioid consumption (morphine via i.v. PCA) during the first 24 postoperative hours. Secondary variables were: pain intensity (numeric rating scale, NRS), sedation, nausea and shivering. Results Morphine consumption was comparable in both groups after 120 min (median ropivacaine: 20 mg; median placebo: 21 mg; p = 0.4) and after 24 h (median ropivacaine: 48 mg; median placebo: 54 mg; p = 0.35). NRS scores showed significant difference only 60 min after PACU arrival (p = 0.012). All other secondary outcome variables failed to reveal significant differences between the groups. Conclusions Compared to placebo, subfascial wound instillation of 40 ml ropivacaine 0.75% (contact time 10 min.) demonstrated almost no analgesic effect after abdominal hysterectomy under remifentanil–isoflurane based general anaesthesia.