TEMPLATE DESIGN © Efficacy of intraperitoneal Ropivacaine in decreasing postoperative pain after laparoscopic tubal sterilization JMK Azhary *NM Adenan*A Rahman** S. Balakrishnan** SZ Omar* *Department of Obstetrics and Gynecology University of Malaya **Department of Obstetrics sand Gynecology Penang General Hospital Introduction Results By 15 th December 2010, 60 patients had been included in the study, in which 30 were allocated in each arm (Intervention and placebo). The demographic data are shown as in Table 1 Method of ligation used were Filshie clips in 58.3% (35 out of 60) the patients. Conclusions Objective OPTIONAL LOGO HERE The objective of this study are :- To assess the severity and the duration of pain following laparoscopic tubal sterilization. To assess the effectiveness of instillation of Ropivacaine into the peritoneal cavity for the relief of post operative pain To prove that combination of intraperitoneal instillation with port sites/skin infiltration of Ropivacaine is better in controlling postoperative pain References Laparoscopic sterilization is probably the most common laparoscopic surgery in the UK and gaining momentum in developing countries in Asia. Regional and general anesthesia are routinely used for this minor operation in most parts of the world including Malaysia. Intraperitoneal lidocaine instillation for postpartum tubal sterilization was first reported in 1973; however, it was limited due to small sample size. Several subsequent studies have proven its efficacy in reducing post operative pain and the need for opiates. Methods The tubes were ligated either with the Filshie clips (Pic. 1) or the Fallop rings (Pic.2) At the end of the procedure, before the abdomen was deflated, 15mls of Ropivacaine (7.5mg/ml Ropivacaine without dilution) or placebo solution (normal saline) is splashed (7.5mls on each tube) on both the ligated tubes with a veress needle under direct vision via the 5mm port. Following skin closure (port skin), the remaining 5mls of Ropivacaine was infiltrated under skin in both study groups Once fully conscious, each patient informed the medical staff of the severity of her pain using a visual analogue score of 1 to 10 at 15, 60,120 and 240 minutes post operation. Need for additional pain relief was assessed and the administration of analgesia was noted (Rescue drug of intravenous Parecoxib 40mg). All patients for elective laparoscopic tubal sterilization with Filshie or Fallop ring between 15 th January 2010 to 15 th December 2010 in Penang general hospital were recruited. Exclusion criteria were patients with known drug allergies to substances contained in the local anaesthesia, Ropivacaine and Parecoxib A standard pre-operative questionnaire were filled up and no pre-medication or any form of analgesia was given prior to procedure. Close technique with veress needle was used at each laparoscopy with the standard insufflation A primary 5 mm port was inserted sub-umbilically as the optic trochar and subsequent 5mm secondary port was inserted into the right or left iliac fossa or suprapubic region under direct vision The intervention group showed lower pain scores at each corresponding times but this are not statistically significant. There is also no significant differences in the mean change of pain score over time between the treatment groups. The mean change between t=15 and t=240, and respectively for the control and intervention group, p= Jack KE, Chao CR. Female voluntary surgical contraception via minilaparotomy under local anesthesia. Int J Gynaecol Obstet 1992;39:111– Ruminjo JK, Lynam PF. A fifteen-year review of female sterilization by minilaparotomy under local anesthesia in Kenya. Contraception 1997;55:249– Cruikshank DP, Laube DW, De Backer LJ. Intraperitoneal lidocaine anesthesia for postpartum tubal ligation. Obstet Gynaecol 1973;42:127– Moiniche S, Jorgensen H, Wetterslev J, Berg J. Local anesthetic infiltration for postoperative pain relief after laparoscopy: a systematic review of intraperitoneal, port-site infiltration and mesosalpinx block. Anesth Analg 2000; 90: 899±912 5.Goldstein A, Grimault P, Henique A,Keller M,Fortin A, Darai E. Preventing Postoperative Pain by Local Anesthetic Instillation After Laparoscopic Gynecologic Surgery: A Placebo-Controlled Comparison of Bupivacaine and Ropivacaine. Anesth Analg 2000;91:403–7 Intraperitoneal Ropivacaine moderately decreases postoperative pain after laparoscopic tubal sterilization with a pain score between 4 to 5. Our findings suggest that the treatment with intraperitoneal Ropivacaine is no more effective than placebo in reducing postoperative pain after laparoscopic tubal sterilization Pic. 1: Application of Filshie clips Pic. 2: Application of Fallop clips With Ropivacaine, the mean pain score at 15 minutes were only 4.07 and 4.07 for patients in the placebo group. The mean pain scores in both the placebo and intervention groups showed decreasing trend with time, reaching about 50 to 60% by 120 minutes. 8. Cruikshank DP, Laube DW, De Backer LJ. Intraperitoneal lidocaine anesthesia for postpartum tubal ligation. Obstet Gynaecol 1973;42:127 – Moiniche S, Jorgensen H, Wetterslev J, Berg J. Local anesthetic infiltration for postoperative pain relief after laparoscopy: a qualitative and quantitative systematic review of intraperitoneal, port-site infiltration and mesosalpinx block. Anesth Analg 2000; 90: 899±912