Local Anesthetic Nebulization for Pain Control After Laparoscopic Cholecystectomy
Local Anesthetic Nebulization for Pain Control After Laparoscopic Cholecystectomy
Intraperitoneal nebulization of local anesthetic is a novel approach to pain management after
 laparoscopy. Preoperative compared with postoperative administration of analgesia remains
 controversial. This randomized, double blind, placebo-controlled trial compared the analgesic
 efficacy of preoperative with postoperative peritoneal ropivacaine nebulization in patients
 undergoing elective laparoscopic cholecystectomy.
Previous studies evaluating intraperitoneal local anesthetic administration for pain relief
 after laparoscopic surgery have suggested that the timing of local anesthetic administration
 may be critical in the success of the technique. A meta-analysis of randomized trials of
 intraperitoneal local anesthetic instillation in patients undergoing laparoscopic surgery
 found that local anesthetic instilled before surgical dissection provided superior pain
 relief compared to instillation at the end of surgery. Intraperitoneal nebulization of local
 anesthetic is a novel approach to pain management after laparoscopic surgery. Recently,
 Alkhamesi et al reported that bupivacaine nebulization performed at the end of laparoscopic
 cholecystectomy significantly reduced postoperative pain. However, clinical benefits of
 preoperative administration of analgesia, compared with postoperative administration, remains
 controversial.

 The investigators hypothesized that pain relief after preoperative and postoperative
 ropivacaine nebulization would be similar but better than placebo.
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