Impact of Intraperitonael Nebulization of Local Anesthetic on Postoperative Pain Associated With Laparoscopic Surgery

Studies evaluating intraperitoneal local anesthetic (LA) instillation for pain relief after laparoscopic surgery have provided conflicting results. One of the factors that might contribute to failure of the instillation technique may be related to inadequate distribution of local anesthetic throughout the peritoneal surface. In contrast, nebulization should provide a uniform spread of drugs throughout the peritoneal cavity and thus may be beneficial to improve pain relief after laparoscopic procedures. The investigators reported that a microvibration-based nebulization device (Aeroneb Pro® system, Aerogen, Galway, Ireland) could be used for ropivacaine delivery into the insufflation gas required to create pneumorpeitoneum. The investigators hypothesized that intraperitoneal ropivacaine nebulization would provide superior pain relief than ropivacaine instillation after gynecologic laparoscopic surgery. This randomized, double blind, controlled clinical trial was designed to assess the analgesic efficacy of ropivacaine nebulization before or after surgery compared with intraperitoneal ropivacaine instillation and placebo after gynecologic laparoscopic procedures.

Inclusion criteria

• Females 18-70 years old, ASA score 1 - 3;
• scheduled for laparoscopic operative surgery in the Obstetrics and Gynecology unit;
• free from pain in preoperative period, without habitual analgesic use;
• without cognitive impairment or mental retardation, who gave a written informed consent

Exclusion criteria

• Females under 18 or over 70;
• ASA 4 or 5;
• emergency/urgency criteria, postoperative admission in a intensive care unit with sedation or ventilatory assistance; cognitive impairment or mental retardation;
• habitual analgesic use; progressive degenerative diseases of the CNS;
• convulsions or chronic therapy with antiepileptic drugs;
• severe hepatic or renal impairment;
• pregnancy or lactation;
• allergy to one of the specific substances used in the study;
• acute infectious disease or inflammatory chronic disease, alcohol or drug addiction;
• any kind of communication problem;
• neurologic or psychiatric disease;
• no written informed consent