Multi-regional local anesthetic infiltration during laparoscopic cholecystectomy in patients receiving prophylactic multi-modal analgesia: A randomized, double-blinded, placebo-controlled study

Pain is the dominant complaint after laparoscopic cholecystectomy. No study has examined the combined effects of a somato-visceral blockade during lap aroscopic cholecystectomy. Therefore, we investigated the effects of a soma to-visceral local anesthetic blockade on pain and nausea in patients underg oing elective laparoscopic cholecystectomy. In addition, an patients receiv ed multi-modal prophylactic analgesic treatment. Fifty-eight patients were randomized to receive a total of 286 mg (66 mL) ropivacaine or 66 mL saline via periportal and intraperitoneal infiltration. During the first 3 postop erative h, the use of morphine and antiemetics was registered, and pain and nausea were rated hourly. Daily pain intensity, pain localization, and sup plemental analgesic consumption were registered the first postoperative wee k. Ropivacaine reduced overall pain the first two hours and incisional pain for the first three postoperative hours (P < 0.01) but had no apparent eff ects on intraabdominal or shoulder pain. During the first 3 postoperative h , morphine requirements were lower (P < 0.05), and nausea was reduced in th e ropivacaine group (P < 0.05). Throughout the first postoperative week, in cisional pain dominated over other pain localizations in both groups (P < 0 .01). We conclude that the somato-visceral local anesthetic blockade reduce d overall pain during the first 2 postoperative h, and nausea, morphine req uirements, and incisional pain were reduced during the first 3 postoperativ e h in patients receiving prophylactic multi-modal analgesic treatment. Imp lications: A combination of incisional and intraabdominal local anesthetic treatment reduced incisional pain but had no effect on deep intraabdominal pain or shoulder pain in patients receiving multimodal prophylactic analges ia after laparoscopic cholecystectomy. Incisional pain dominated during the first postoperative week. Incisional infiltration of local anesthetics is recommended in patients undergoing laparoscopic cholecystectomy.