The effect of intraperitoneal local anaesthetic instillation and infusion on functional recovery following colectomy

Abstract

Purpose: Intraperitoneal local anaesthetic (IPLA) is a new analgesic technique for inclusion in the polypharmacy approach to postoperative pain management in enhanced-recovery-after-surgery (ERAS) programs. This study determines the effect of IPLA on postoperative pain and functional recovery in patients undergoing colectomy. Methodology: Multi-site, double-blinded, randomized, placebo-controlled trial design: ClinicalTrials.gov Identifier NCT02449720. Adults undergoing colectomy (35 open; 51 laparoscopic) received i.p. ropivacaine 100mg instillation both pre- and post-dissection and 20mg/hr continuous postoperative infusion for 48hrs (IPLA group), or a normal saline equivalent (Control Group). A standardised ERAS program was used in perioperative care. Data collected included baseline demographics, functional postoperative recovery using the surgical-recovery-scale (SRS), postoperative pain using a visual-analogue-scale (VAS), opioid consumption, use of rescue ketamine, recovery of bowel function, time-to-readiness-for-discharge (TRD), and perioperative complications. Participants were followed for 45 days. Results: Eighty-six participants were recruited (IPLA n=44; Control n=42). The IPLA group reported improved SRS scores at day 1 and 7, lower pain scores, required less rescue ketamine, and passed flatus earlier than the Control group (P<0.05). The improved SRS at day 7 and pain scores remained present when the subset of participants undergoing laparoscopically-assisted colectomy were considered separately. There was no difference between the groups in opioid consumption or TRD. Conclusion: Instillation and infusion of intraperitoneal ropivacaine for patients undergoing colectomy is safe, decreases pain, and improves functional recovery. We recommend routine inclusion of IPLA into the multimodal analgesia component of ERAS programs for colectomy.