Peritoneal nebulization of ropivacaine during laparoscopic cholecystectomy: Dose finding and pharmacokinetic study

Massimo Allegri, Martina Ornaghi, Catherine E. Ferland, Dario Bugada, Yash Meghani, Serena Calcinati, Manuela De Gregori, Federica Lovisari, Krishnaprabha Radhakrishnan, Maria Cusato, Stefano Scalia Catenacci, Marta Somaini, Guido Fanelli, Pablo Ingelmo

Research output: Contribution to journalArticle

Abstract

Background. Intraperitoneal nebulization of ropivacaine reduces postoperative pain andmorphine consumption after laparoscopic surgery. The aim of this multicenter double-blind randomized controlled trial was to assess the efficacy of different doses and dose-related absorption of ropivacaine when nebulized in the peritoneal cavity during laparoscopic cholecystectomy. Methods. Patients were randomized to receive 50, 100, or 150mg of ropivacaine 1% by peritoneal nebulization through a nebulizer.Morphine consumption, pain intensity in the abdomen, wound and shoulder, time to unassisted ambulation, discharge time, and adverse effects were collected during the first 48 hours after surgery. The pharmacokinetics of ropivacaine was evaluated using high performance liquid chromatography. Results. Nebulization of 50mg of ropivacaine had the same effect of 100 or 150mg in terms of postoperative morphine consumption, shoulder pain, postoperative nausea and vomiting, activity resumption, and hospital discharge timing (>0.05). Plasma concentrations did not reach toxic levels in any patient, and no significant differences were observed between groups (P > 0.05). Conclusions. There is no enhancement in analgesic efficacy with higher doses of nebulized ropivacaine during laparoscopic cholecystectomy. When administered with a microvibration-based aerosol humidification system, the pharmacokinetics of ropivacaine is constant and maintains an adequate safety profile for each dosage tested.

Original languageEnglish
Article number4260702
JournalPain Research and Management
Volume2017
DOIs
Publication statusPublished - Jan 1 2017

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Laparoscopic Cholecystectomy
Pharmacokinetics
Morphine
Postoperative Nausea and Vomiting
Shoulder Pain
Poisons
Nebulizers and Vaporizers
Peritoneal Cavity
Postoperative Pain
ropivacaine
Aerosols
Abdomen
Laparoscopy
Walking
Analgesics
Randomized Controlled Trials
High Pressure Liquid Chromatography
Safety
Pain
Wounds and Injuries

ASJC Scopus subject areas

  • Neurology
  • Anesthesiology and Pain Medicine

Cite this

Allegri, M., Ornaghi, M., Ferland, C. E., Bugada, D., Meghani, Y., Calcinati, S., ... Ingelmo, P. (2017). Peritoneal nebulization of ropivacaine during laparoscopic cholecystectomy: Dose finding and pharmacokinetic study. Pain Research and Management, 2017, [4260702]. https://doi.org/10.1155/2017/4260702

Peritoneal nebulization of ropivacaine during laparoscopic cholecystectomy : Dose finding and pharmacokinetic study. / Allegri, Massimo; Ornaghi, Martina; Ferland, Catherine E.; Bugada, Dario; Meghani, Yash; Calcinati, Serena; De Gregori, Manuela; Lovisari, Federica; Radhakrishnan, Krishnaprabha; Cusato, Maria; Catenacci, Stefano Scalia; Somaini, Marta; Fanelli, Guido; Ingelmo, Pablo.

In: Pain Research and Management, Vol. 2017, 4260702, 01.01.2017.

Research output: Contribution to journalArticle

Allegri, M, Ornaghi, M, Ferland, CE, Bugada, D, Meghani, Y, Calcinati, S, De Gregori, M, Lovisari, F, Radhakrishnan, K, Cusato, M, Catenacci, SS, Somaini, M, Fanelli, G & Ingelmo, P 2017, 'Peritoneal nebulization of ropivacaine during laparoscopic cholecystectomy: Dose finding and pharmacokinetic study', Pain Research and Management, vol. 2017, 4260702. https://doi.org/10.1155/2017/4260702
Allegri, Massimo ; Ornaghi, Martina ; Ferland, Catherine E. ; Bugada, Dario ; Meghani, Yash ; Calcinati, Serena ; De Gregori, Manuela ; Lovisari, Federica ; Radhakrishnan, Krishnaprabha ; Cusato, Maria ; Catenacci, Stefano Scalia ; Somaini, Marta ; Fanelli, Guido ; Ingelmo, Pablo. / Peritoneal nebulization of ropivacaine during laparoscopic cholecystectomy : Dose finding and pharmacokinetic study. In: Pain Research and Management. 2017 ; Vol. 2017.
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abstract = "Background. Intraperitoneal nebulization of ropivacaine reduces postoperative pain andmorphine consumption after laparoscopic surgery. The aim of this multicenter double-blind randomized controlled trial was to assess the efficacy of different doses and dose-related absorption of ropivacaine when nebulized in the peritoneal cavity during laparoscopic cholecystectomy. Methods. Patients were randomized to receive 50, 100, or 150mg of ropivacaine 1{\%} by peritoneal nebulization through a nebulizer.Morphine consumption, pain intensity in the abdomen, wound and shoulder, time to unassisted ambulation, discharge time, and adverse effects were collected during the first 48 hours after surgery. The pharmacokinetics of ropivacaine was evaluated using high performance liquid chromatography. Results. Nebulization of 50mg of ropivacaine had the same effect of 100 or 150mg in terms of postoperative morphine consumption, shoulder pain, postoperative nausea and vomiting, activity resumption, and hospital discharge timing (>0.05). Plasma concentrations did not reach toxic levels in any patient, and no significant differences were observed between groups (P > 0.05). Conclusions. There is no enhancement in analgesic efficacy with higher doses of nebulized ropivacaine during laparoscopic cholecystectomy. When administered with a microvibration-based aerosol humidification system, the pharmacokinetics of ropivacaine is constant and maintains an adequate safety profile for each dosage tested.",
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AU - Allegri, Massimo

AU - Ornaghi, Martina

AU - Ferland, Catherine E.

AU - Bugada, Dario

AU - Meghani, Yash

AU - Calcinati, Serena

AU - De Gregori, Manuela

AU - Lovisari, Federica

AU - Radhakrishnan, Krishnaprabha

AU - Cusato, Maria

AU - Catenacci, Stefano Scalia

AU - Somaini, Marta

AU - Fanelli, Guido

AU - Ingelmo, Pablo

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AB - Background. Intraperitoneal nebulization of ropivacaine reduces postoperative pain andmorphine consumption after laparoscopic surgery. The aim of this multicenter double-blind randomized controlled trial was to assess the efficacy of different doses and dose-related absorption of ropivacaine when nebulized in the peritoneal cavity during laparoscopic cholecystectomy. Methods. Patients were randomized to receive 50, 100, or 150mg of ropivacaine 1% by peritoneal nebulization through a nebulizer.Morphine consumption, pain intensity in the abdomen, wound and shoulder, time to unassisted ambulation, discharge time, and adverse effects were collected during the first 48 hours after surgery. The pharmacokinetics of ropivacaine was evaluated using high performance liquid chromatography. Results. Nebulization of 50mg of ropivacaine had the same effect of 100 or 150mg in terms of postoperative morphine consumption, shoulder pain, postoperative nausea and vomiting, activity resumption, and hospital discharge timing (>0.05). Plasma concentrations did not reach toxic levels in any patient, and no significant differences were observed between groups (P > 0.05). Conclusions. There is no enhancement in analgesic efficacy with higher doses of nebulized ropivacaine during laparoscopic cholecystectomy. When administered with a microvibration-based aerosol humidification system, the pharmacokinetics of ropivacaine is constant and maintains an adequate safety profile for each dosage tested.

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