Intraperitoneal ropivacaine for post-operative pain following laparoscopic tubal ligation: a randomised double-blind placebo-controlled trial

Abstract

Intraperitoneal ropivacaine for post-operative pain following laparoscopic tubal ligation: a randomised double-blind placebo-controlled trial Jerilee Mariam Khong Azhary1,2, *, Aizura Syafinaz Adlan2, *, Sivakumar S. Balakrishnan1 , Siti Rohayu Kamarul Baharain1 , Syeda Nureena Syed Jafer Hussain Zaidi2 , Nuguelis Razali2 , Mukhri Hamdan2 , Noor Azmi Mat Adenan2 , Siti Zawiah Omar2 1Department of Obstetrics and Gynecology, Penang General Hospital, Jalan Residensi, 10990 George Town, Pulau Pinang, Malaysia 2Department of Obstetrics and Gynecology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia *Correspondence: jag23k@yahoo.com (Jerilee Mariam Khong Azhary); aizuraadlan@gmail.com (Aizura Syafinaz Adlan) DOI:10.31083/j.ceog.2021.03.2476 This is an open access article under the CC BY 4.0 license (https://creativecommons.org/licenses/by/4.0/). Submitted: 17 January 2021 Revised: 7 March 2021 Accepted: 18 March 2021 Published: 15 June 2021 Background: Female sterilisation is the most common method of contraception worldwide and laparoscopic tubal sterilisation is increasingly considered as a day-surgery procedure. Therefore, pain following this procedure should be seriously addressed. Instillation of 200 to 300 mg of ropivacaine intraperitoneally has been proven effective in controlling pain after laparoscopic tubal ligation (LTL). However, extreme caution must be taken as potential serum toxicity has been reported with the instillation of 150 mg of intraperitoneal ropivacaine. In search of the lowest, most effective dose, this study aimed to evaluate the effectiveness of 112.5 mg of ropivacaine intraperitoneally in reducing post-operative pain after LTL. Methods: This double-blind, placebo-controlled randomised trial was conducted in an ambulatory care centre in Malaysia. Sixty-two patients scheduled for LTL were recruited. Two patients were excluded from the trial because of intraoperative complications. Sixty patients were randomised to either the placebo group (intraperitoneal normal saline, n = 30) or the ropivacaine group (intraperitoneal ropivacaine, n = 30). Pain scores (using a visual analogue score), and the need for additional analgesia were assessed at 15, 60, 120, and 240 minutes post-LTL. Results: We observed no significant differences in pain scores or the need for additional analgesia between the groups. Conclusion: 112.5 mg of ropivacaine administered intraperitoneally is not more effective than normal saline in decreasing post-operative pain after LTL. Keywords Intraperitoneal analgesia; Laparoscopic tubal ligation; Post-operative pain; Ropivacaine