Randomized trial of subfascial infusion of ropivacaine for early recovery in laparoscopic colorectal cancer surgery

Sang Hyun Lee, Woo-Seog Sim, Go Eun Kim, Hee Cheol Kim, Joo Hyun Jun, Jin Young Lee, Byung-Seop Shin, Heejin Yoo, Sin-Ho Jung, Joungyoun Kim, Seung Hyeon Lee, Deok Kyu Yo, Yu Ri Na, Sang Hyun Lee, Woo-Seog Sim, Go Eun Kim, Hee Cheol Kim, Joo Hyun Jun, Jin Young Lee, Byung-Seop Shin, Heejin Yoo, Sin-Ho Jung, Joungyoun Kim, Seung Hyeon Lee, Deok Kyu Yo, Yu Ri Na

Abstract

Background: There is a need for investigating the analgesic method as part of early recovery after surgery tailored for laparoscopic colorectal cancer (LCRC) surgery. In this randomized trial, we aimed to investigate the analgesic efficacy of an inverse 'v' shaped bilateral, subfascial ropivacaine continuous infusion in LCRC surgery.

Methods: Forty two patients undergoing elective LCRC surgery were randomly allocated to one of two groups to receive either 0.5% ropivacaine continuous infusion at the subfascial plane (n = 20, R group) or fentanyl intravenous patient controlled analgesia (IV PCA) (n = 22, F group) for postoperative 72 hours. The primary endpoint was the visual analogue scores (VAS) when coughing at postoperative 24 hours. Secondary end points were the VAS at 1, 6, 48, and 72 hours, time to first flatus, time to first rescue meperidine requirement, rescue meperidine consumption, length of hospital stay, postoperative nausea and vomiting, sedation, hypotension, dizziness, headache, and wound complications.

Results: The VAS at rest and when coughing were similar between the groups throughout the study. The time to first gas passage and time to first rescue meperidine at ward were significantly shorter in the R group compared to the F group (P = 0.010). Rescue meperidine was administered less in the R group; however, without statistical significance. Other study parameters were not different between the groups.

Conclusions: Ropivacaine continuous infusion with an inverse 'v ' shaped bilateral, subfascial catheter placement showed significantly enhanced bowel recovery and analgesic efficacy was not different from IV PCA in LCRC surgery.

Keywords: Analgesia; Colorectal surgery; Laparoscopy; Local anesthetics; Ropivacaine; Subfascia.

Figures

Fig. 1. Laparoscopically assisted ropivacaine continuous infusion…
Fig. 1. Laparoscopically assisted ropivacaine continuous infusion (Painbuster™) catheter placement at subfascial layer (preperitoneum). Arrow indicates a catheter placed just beneath the parietal peritoneum.
Fig. 2. CONSORT flow diagram.
Fig. 2. CONSORT flow diagram.
LCRC: laparoscopic colorectal cancer.

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