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The Impact of Laparoscopic Intraperitoneal Instillation of Ropivacaine in Enhancing Respiratory Recovery and Reducing Acute Postoperative Pain in Laparoscopic Sleeve Gastrectomy: a Double-Blinded Randomised Control; RELiEVE Trial

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Abstract

Purpose

Laparoscopic intraperitoneal instillation of local anaesthetic in bariatric surgery proven to reduce postoperative pain. Limited data are available regarding the use of instillation ropivacaine and its impact on the recovery of respiratory effort. This study aims to evaluate the efficacy of laparoscopic intraperitoneal instillation of ropivacaine in reducing acute postoperative pain and enhancing the recovery of respiratory effort in laparoscopic sleeve gastrectomy.

Materials and Methods

This double-blinded RCT enrolled 110 patients who underwent laparoscopic sleeve gastrectomy at Hospital Canselor Tuanku Muhriz UKM from November 2020 to May 2021. Any patients with previous abdominal surgery, chronic kidney disease, or liver disease were excluded. The patients were randomised into two groups: (i) the IPLA group which received ropivacaine intraperitoneal instillation at the dissected left crus and (ii) the placebo group (sterile water instillation). Perioperative analgesia was standardised. The first 24-h postoperative pain was assessed using a VAS. The respiratory effort was assessed using incentive spirometry simultaneously.

Results

Total of 110 patients were recruited. The VAS score was lower with an enhanced recovery of respiratory effort in the local anaesthetic group compared to the placebo group (P < 0.05) within the first 24 h postoperatively. In addition, the placebo group required additional postoperative analgesia (P < 0.05). No side effects were reported with the use of intraperitoneal instillation of ropivacaine.

Conclusion

The use of intraperitoneal instillation of ropivacaine in laparoscopic sleeve gastrectomy is recommended as it is safe, effectively reduces acute postoperative pain, and enhances the recovery of respiratory effort postoperatively.

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Data Availability

Conclusion made based on the results/findings of this study.

Abbreviations

BMI:

Body mass index

DM:

Diabetes mellitus

GA:

General anaesthesia

HTN:

Hypertension

IPLA:

Instillation peritoneal local anaesthesia

IQR:

Interquartile range

IV:

Intravenous

LA:

Local anaesthesia

LSGS:

Laparoscopic sleeve gastrectomy surgery

NSAID:

Non-steroidal anti-inflammatory drugs

OSA:

Obstructive sleep apnoea

OT:

Operating theatre

RCT:

Randomised control trial

VAS:

Visual analogue score

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Author information

Authors and Affiliations

  1. Upper-Gastrointestinal Surgery Unit, MIS, Bariatric Surgery Unit, Department of Surgery, Faculty of Medicine, Hospital Canselor Tuanku Muhriz UKM, Kuala Lumpur, Malaysia

    Lee Qi Zheng & Nik Ritza Kosai

  2. Department of Surgery, Faculty of Medicine, Universiti Teknologi MARA, Jalan Ilmu 1/1, 40450, Shah Alam, Selangor, Malaysia

    Mohd Firdaus Che Ani

  3. Department of Anaesthesiology & Critical Care, Hospital Canselor Tuanku Muhriz UKM, Kuala Lumpur, Malaysia

    Muhammad Maaya

Authors
  1. Lee Qi Zheng
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  2. Nik Ritza Kosai
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  3. Mohd Firdaus Che Ani
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  4. Muhammad Maaya
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Corresponding author

Correspondence to Lee Qi Zheng.

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Key Points

• This double-blinded trial study aims to evaluate the efficacy of laparoscopic intraperitoneal instillation of ropivacaine in reducing acute postoperative pain and enhancing the recovery of respiratory effort in laparoscopic sleeve gastrectomy.

• This trial enrolled 110 patients.

• The use of intraperitoneal instillation of ropivacaine in laparoscopic sleeve gastrectomy is safe.

• It reduces acute postoperative pain significantly.

• It also enhances the recovery of respiratory effort.

• Hence, intraperitoneal instillation of LA should be used in laparoscopic sleeve gastrectomy surgery.

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Zheng, L.Q., Kosai, N.R., Ani, M.F.C. et al. The Impact of Laparoscopic Intraperitoneal Instillation of Ropivacaine in Enhancing Respiratory Recovery and Reducing Acute Postoperative Pain in Laparoscopic Sleeve Gastrectomy: a Double-Blinded Randomised Control; RELiEVE Trial. OBES SURG 33, 3141–3146 (2023). https://doi.org/10.1007/s11695-023-06777-y

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  • DOI: https://doi.org/10.1007/s11695-023-06777-y

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