School of Medicine Sydney, Rural Clinical School (Wagga Wagga), The University of Notre Dame Australia, 40 Hardy Avenue, PO Box 5050, Wagga Wagga, NSW, 2650, Australia.
Anesthetic Department, Calvary Hospital Riverina, 26-36 Hardy Avenue, Wagga Wagga, NSW, 2650, Australia.
Obes Surg. 2022 Jul;32(7):2349-2356. doi: 10.1007/s11695-022-06086-w. Epub 2022 May 4.
Effective analgesia after bariatric procedures is vital as it can reduce post-operative opioid use. This leads to less nausea which may be associated with shorter post-operative length of stay (LOS). Understanding analgesic requirements in patients with obesity is important due to the varied physiology and increased number of comorbidities.
The aim of this study was to evaluate the efficacy of intraperitoneal instillation of local anesthetic (IPILA) to reduce opioid requirements in patients undergoing laparoscopic bariatric surgery.
A double-blinded randomized control trial was conducted to compare intraperitoneal instillation of ropivacaine to normal saline in 104 patients undergoing bariatric surgery. The primary endpoint was pain in recovery with secondary endpoints at 1, 2, 4, 6, 24, and 48 h post-operatively. Further endpoints were post-operative analgesic use and LOS. Safety endpoints included unexpected reoperation or readmission, complications, and mortality.
There were 54 patients in the placebo arm and 50 in the IPILA. Pain scores were significantly lower in the IPILA group both at rest (p = 0.04) and on movement (p = 0.02) in recovery with no difference seen at subsequent time points. Equally, IPILA was independently associated with reducing severe post-operative pain at rest and movement (adjusted odds ratio [aOR] 0.28, 95% CI 0.11-0.69, p = 0.007 and aOR 0.25, 95% CI 0.09-0.62, p = 0.004, respectively). There was no significant difference in LOS, opioid use, antiemetic use, morbidity, or mortality between the intervention and placebo groups.
The administration of ropivacaine intraperitoneally during laparoscopic bariatric surgery reduces post-operative pain in the recovery room but does not reduce opioid use nor LOS.
有效的术后镇痛对于减重手术至关重要，因为它可以减少术后阿片类药物的使用。这可以减少恶心的发生，从而可能缩短术后住院时间（LOS）。由于肥胖患者的生理学变化和合并症的增加，了解其镇痛需求非常重要。
本研究旨在评估腹腔内局部麻醉药（IPILA）灌注以减少腹腔镜减重手术患者阿片类药物需求的效果。
进行了一项双盲随机对照试验，比较了罗哌卡因腹腔内灌注与生理盐水在 104 例接受减重手术的患者中的效果。主要终点是恢复时的疼痛，次要终点为术后 1、2、4、6、24 和 48 小时。进一步的终点是术后镇痛使用和 LOS。安全性终点包括意外再次手术或再入院、并发症和死亡率。
安慰剂组有 54 例患者，IPILA 组有 50 例患者。IPILA 组在恢复时的静息（p=0.04）和运动（p=0.02）时疼痛评分均显著降低，而在随后的时间点则无差异。同样，IPILA 与减少术后静息和运动时的严重疼痛独立相关（调整后的优势比 [aOR] 0.28，95%CI 0.11-0.69，p=0.007 和 aOR 0.25，95%CI 0.09-0.62，p=0.004）。干预组和安慰剂组之间在 LOS、阿片类药物使用、止吐药使用、发病率或死亡率方面无显著差异。
在腹腔镜减重手术期间腹腔内给予罗哌卡因可减少恢复室中的术后疼痛，但不会减少阿片类药物的使用或 LOS。
