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Korean J Anesthesiol > Epub ahead of print
DOI: https://doi.org/10.4097/kja.d.18.00290    [Epub ahead of print]
Published online April 15, 2019.
Intraperitoneal nebulization versus intraperitoneal instillation of ropivacaine for postoperative pain management following laparoscopic donor nephrectomy
Rajeev Kumar1, Soumya Shankar1, Anil Agarwal2
1Department Of Anesthesiology, Dr. Ram Manohr Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
2Department of Anesthesiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
Corresponding author:  Rajeev Kumar, Tel: +91 8004019936, 
Email: dr.rajeevkumar2@gmail.com
Received: 8 October 2018   • Revised: 23 February 2019   • Accepted: 3 April 2019
Abstract
Background
Laparoscopic donor nephrectomy is considered less painful compared to open nephrectomy but is still associated with the significant postoperative pain. Studies reported that intraperitoneal instillation of local anesthetic provides uncertain pain relief after laparoscopic surgery. This randomized double-blind study aims to evaluate the effect of intraperitoneal nebulization of ropivacaine on postoperative pain relief after laparoscopic donor nephrectomy.
Methods
This study includes 60 patients undergoing elective laparoscopic donor nephrectomy were randomly assigned to receive either instillation of ropivacaine 0.5%, 20 ml after induction of pneumoperitoneum or nebulization of ropivacaine 1%, 5 ml before and after surgery. The primary outcome of this study was the degree of pain relief (static and dynamic) after surgery. Secondary outcomes were postoperative fentanyl requirement, the incidence of shoulder pain, postoperative nausea and vomiting. Data were collected in the post-anesthesia care unit and at 6, 24 and 48 hours after surgery.
Results
Significant reduction in postoperative pain and fentanyl consumption were noted in nebulization group and no patient complained of significant shoulder pain (VAS ≥ 30 mm) in comparison to patients in the instillation group. Within 20 hours of surgery, 13.3% patients of instillation group and 93.3% of nebulization group started unassisted walking (absolute risk reduction 38%, P = 0.001). In ropivacaine nebulization group PONV was significantly reduce in PACU and at 6 hr.
Conclusions
Intraperitoneal nebulization of ropivacaine reduced postoperative pain, fentanyl requirements, referred shoulder pain, PONV with earlier mobility but with no difference in duration of the hospital stay.
Key Words: Acute pain, donor nephrectomy, instillation, local anesthetics, laparoscopic, nebulization, post-anesthesia care unit, ropivacaine


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