Local Anesthetic Nebulization and Instillation for Pain Control After Laparoscopic Surgery
Local Anesthetic Nebulization and Instillation for Pain Control After Laparoscopic Surgery
Studies evaluating intraperitoneal local anesthetic instillation for pain relief after
 laparoscopic procedures have provided conflicting results. This randomized, double-blind
 study was designed to assess the effects of a novel intraperitoneal local anesthetic
 administration technique using nebulization on pain relief after laparoscopic
 cholecystectomy.
Studies evaluating intraperitoneal local anesthetic (LA) instillation for pain relief after
 laparoscopic cholecystectomy 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. A recent study reported that
 bupivacaine nebulization significantly reduced pain after laparoscopic cholecystectomy
 compared with bupivacaine instillation in the gallbladder bed. However, these investigators
 used a custom-made nebulization system that needs a separate gas source and tubing that is
 cumbersome and may not be easily available.

 Recently, 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 after
 laparoscopic cholecystectomy than intraperitoneal ropivacaine instillation. This randomized,
 double blind, controlled clinical trial was designed to assess the analgesic efficacy of
 ropivacaine nebulization using the Aeroneb Pro® device laparoscopic cholecystectomy compared
 with intraperitoneal ropivacaine instillation.
Inclusion Criteria:

 -  ASA Score I-III

 -  Scheduled for laparoscopic cholecystectomy

 -  Free from pain in preoperative period

 -  Not using analgesic drugs before surgery

 -  Without cognitive impairment or mental retardation

 -  Written informed consent

 Exclusion Criteria:

 -  Emergency/urgency surgery

 -  Postoperative admission in an intensive care unit

 -  Cognitive impairment or mental retardation

 -  Progressive degenerative diseases of the CNS

 -  Seizures or chronic therapy with antiepileptic drugs

 -  Severe hepatic or renal impairment

 -  Pregnancy or lactation

 -  Allergy to one of the specific drugs under study

 -  Acute infection or inflammatory chronic disease

 -  Alcohol or drug addiction