Intraperitoneal ropivacaine or ropivacaine plus meperidine for laparoscopic gynecological procedures

Abstract

Objective: Postoperative pain after laparoscopic surgery is less intense than after laparotomy and patients may benefit from an intraperitoneal injection of local anesthetic and opioids. We aimed to compare intraperitoneal 0.75% ropivacaine with 0.75% ropivacaine plus meperidine for postoperative analgesia in patients undergoing gynecologic laparoscopy.
Material and Methods: At the end of gynecologic laparoscopy, in a double–blind, randomized manner, one of the following injections was given intraperitoneally. Patients were allocated into three groups: patients in R Group (n= 18) were given 0.75% ropivacaine 3 mg/kg in 200 mL saline; patients in RM Group (n= 17) were given meperidine 50 mg plus 0.75% ropivacaine 3 mg/kg in 200 mL saline; patients in C Group (n= 18) were given 200 mL saline through the trocars. All patients were given diclofenac sodium when they had pain (VAS ³ 3) and 1 mg/kg meperidine i.v. was also given when pain persisted.
Results: The pain scores and analgesic requirements during the first postoperative hour were significantly lower in the RM Group than those in the R and C Groups. Beyond that time, the pain scores were similar in all groups and there were no differences in total analgesic requirement in 24 h between groups. The three groups were comparable for shoulder pain and side effects.
Conclusion: The intraperitoneal infiltration of 0.75% ropivacaine plus meperidine reduced pain scores and analgesic requirement during the first one hour after gynecologic laparoscopy compared with the intraperitoneal infiltration of ropivacaine or saline.