Nebulized analgesia during laparoscopic appendectomy (NALA): A randomized triple-blind placebo controlled trial
jpedsurg.org shows its articles on its own site.
Read the article on jpedsurg.org ↗Article · Oct 2018 · 1 min read
In brief
In brief
This Level I randomized controlled trial evaluated nebulized ropivacaine versus placebo during laparoscopic appendectomy in 116 pediatric patients aged 7-17 years. Results showed no reduction in morphine consumption or pain scores, with surgeons reporting impaired visualization in 63% of cases, leading investigators to conclude the technique is not warranted for uncomplicated appendicitis.
Written by the GCMD Library team from the article.
Purpose
Postoperative pain remains a considerable concern for patients and families. We assessed whether nebulized ropivacaine reduces morphine consumption and pain after laparoscopic appendectomy for uncomplicated appendicitis in children.
Methods
Patients 7–17 years old with uncomplicated appendicitis were randomized to ropivacaine (intervention arm) or saline nebulization (placebo arm) at the onset of laparoscopy. Nonconsenting individuals were treated with standard care and invited to provide clinical data (baseline arm). The primary outcome was in-patient morphine utilization. Secondary outcomes included pain scores at multiple time-points, markers of recovery, operative times, and surgeon satisfaction. The trial was registered (NCT02624089).
Results
Study enrollment was 116 patients over a 1-year period: Intervention (n = 43), Placebo (n = 39), Baseline (n = 34). No differences in baseline characteristics were noted between groups. No difference was noted in overall in-patient morphine consumption between randomized groups (0.31 vs. 0.35 mg/kg, p = 0.42) or between ropivacaine and baseline (0.31 vs. 0.277 mg/kg, p = 0.62). Although operative times were comparable between groups, 63% of surgeon respondents felt that nebulization obscured visualization.
Conclusion
Nebulized ropivacaine did not reduce postoperative morphine consumption or pain scores after laparoscopic appendectomy for simple appendicitis in children. Given that it decreases visualization and likely increases costs, nebulized administration of intraperitoneal analgesia does not appear warranted in this context.
Type of study
Treatment study.
Level of evidence
Level I.