Clinical Observation Of Intraperitoneal Ropivacaine Infusion For Postoperative Shoulder Pain Relief At The Beginning Of Gynecological Laparoscopic Surgery

Purpose：With the development of minimal invasive surgery,the benefitsof laparoscopic surgery compared with open surgery are well known. Whilethe complication, post-laparoscopic pain, draws the attention of surgeons.Some scholars call it postlaparoscopic pain syndrome. Postoperative paincomponents are incisional pain (parietal pain component), deepintraabdominal pain (visceral pain component), and shoulder pain (presumablyreferred visceral pain). But other kind of pain may cause more discomfort tothe patient than the pain at the incision sites. The incidence of shoulder painvaries from35%to80%and ranges from mild to severe. There are studiesabout local anesthetic intraperitoneal infusion at home and abroad,while thereare few studies about gynecological laparoscopic surgery.Ropivacaine is one of the long-acting amide local anesthetics derivativeswhich have a long-acting duration and can relieve pain. The pharmacologycharacters of ropivacaine are low cardiac toxity, obviously seperation betweensensation blocking and motion blocking, constriction of peripheral vascular.The characteristic low lipid solubility of ropivacaine makes long-actingduration of anesthesia. Considered about the differences among oriental andwesterners, safety and practicality, in this study we chose75mg.The purpose of this study is to observe introperitoneal0.075%ropivacaine100ml subdiaphragmatic infusion for postoperative pain relief atthe beginning of gynecological laparoscopic surgery.Methods: A total of200patients who were scheduled for electivegynecologic laparoscopic surgery under general anesthesia were randomlyallocated to either control group (group B, n=100) or experimental group(group A, n=100). The anesthesiologists followed the same general anesthetic protocol.Anesthesia was induced using midazolam injection0.05～0.1mg/kg,sufentanil0.2～0.3μg/kg, propofol1～2.5mg/kg, rocuronium bromide0.5～1mg/kg, propofol and remifentanil to maintain anesthesia.At the beginning of the surgery, pneumoperitoneum was performed usingCO2and created with a10mm umbilical trocar. After all the other trocars hadbeen placed, all patients were placed in head-down tilt (30), then group Ahad intraperitoneal subdiaphragmatic infusion of0.075%ropivacaine withnormal saline100ml. During laparoscopy, intraabdominal pressure wasadjusted to sustain a pressure of14mm Hg.During the surgery, patients of two groups were monitored with bloodpressure,pulse,ECG,PETCO2,PaO2and respiratory parameters are adjustedto maintain PETCO2between35～40mm Hg.After the surgery, shoulder pain were registered at2,4,8,12,24,48hours postoperatively using a Visual Analog Scale(VAS). Nausea andvomiting (PONV) and additional analgesic requirements were recorded.Adverse reaction of ropivacaine should be recorded and treated timely.All statistical analyses were conducted with SPSS version19.0statisticalsoftware．The level of significance was set at0.05.Results:1There were no significant differences in the demographic characteristics ofthe patients in the two groups(P>0.05).2Positive rate of group A (27%) was lower than group B(42%).3Shoulder pain scores analyses showed statistically significant differencesbetween group A and group B at2,4,8,12and24hours (P<0.05). Shoulderpain scores of group A at48hours was lower than group B, while there wasno statistically significant differences (P>0.05).4Additional analgesic requirements between group A (n=3) and group B(n=12) showed statistically significant differences (P<0.05).5No side effects could be attributed to the use of ropivacaine or to theapplication technique. Conclusion：0.075%ropivacaine100ml subdiaphragmatic infusion atthe beginning of gynecological laparoscopic surgery can safely and effectivelydecrease the incidence and intensity of postoperative shoulder pain.