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The LAPLAP study: a randomized placebo‐controlled clinical trial assessing postoperative functional recovery using intraperitoneal local anaesthetic in laparoscopic colorectal surgery
Author(s) -
Stephensen B. D.,
Clarke L.,
McManus B.,
Clark S.,
Carroll R.,
Holz P.,
Smith S. R.
Publication year - 2019
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/codi.14720
Subject(s) - medicine , ropivacaine , colorectal surgery , anesthesia , randomized controlled trial , placebo , surgery , analgesic , laparoscopy , morphine , laparoscopic surgery , opioid , adverse effect , abdominal surgery , alternative medicine , receptor , pathology
Abstract Aim Postoperative pain remains a major factor in recovery from colorectal resection. There is increasing interest in opioid‐sparing analgesia, and intraperitoneal local anaesthetic (IPLA) has recently been shown to be useful in minor laparoscopic and open colorectal procedures. The aim of this study was to evaluate the impact of IPLA on functional recovery following major laparoscopic surgery. In this controlled trial, mobility, as measured by the De Morton Mobility Index (DEMMI), was used as a surrogate for postoperative functional recovery. Method Patients undergoing laparoscopic colorectal resection were randomized either to continuous ropivacaine (0.2% at 4–6 ml/h) or to saline (0.9%) which were administered via intraperitoneal catheter for 3 days postoperatively. Results were analysed in a double‐blind manner. DEMMIs were assessed on postoperative days 1, 2, 3, 7 and 30, and data on pain, opioid consumption, gut and respiratory function, length of stay (LOS) and complications were recorded. Results Ninety‐six patients were recruited. There was no difference in primary outcome (i.e., functional recovery) between IPLA and placebo groups. Opioid consumption and LOS were similar between groups, and no differences were found for any secondary outcome measure. There were no adverse events related to ropivacaine. Conclusion Infusional intraperitoneal local anaesthetic appears to be safe but does not improve functional recovery or analgesic consumption following elective laparoscopic colorectal surgery, in the setting of an established enhanced recovery programme.