Prospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 28, 2017; 23(36): 6733-6740
Published online Sep 28, 2017. doi: 10.3748/wjg.v23.i36.6733
Effect of local wound infiltration with ropivacaine on postoperative pain relief and stress response reduction after open hepatectomy
Jing-Xian Sun, Ke-Yun Bai, Yan-Feng Liu, Gang Du, Zhi-Hao Fu, Hao Zhang, Jin-Huan Yang, Ben Wang, Xiu-Yu Wang, Bin Jin
Jing-Xian Sun, Ke-Yun Bai, Department of Anorectal Surgery, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250011, Shandong Province, China
Yan-Feng Liu, Gang Du, Zhi-Hao Fu, Hao Zhang, Jin-Huan Yang, Ben Wang, Bin Jin, Department of Hepatobiliary Surgery, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China
Xiu-Yu Wang, Department of Anesthesiology, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China
Author contributions: Sun JX collected the data and drafted the manuscript; Liu YF, Fu ZH, Zhang H, Yang JH and Wang XY contributed to data collection and statistical analysis; Du G and Wang B helped revise the manuscript; Jin B and Bai KY contributed to the study design and revised the manuscript; all authors read and approved the final manuscript.
Supported by National Natural Science Foundation of China, No. 81571367 and No. 81502050; Scientific and Technological Project of Shandong Province, No. 2016GSF201082.
Institutional review board statement: This study was approved by the Medical Ethics Committee of Qilu Hospital of Shandong University (No. 2017052).
Informed consent statement: All involved patients provided informed consent prior to the study inclusion.
Conflict-of-interest statement: We declare that we have no conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Bin Jin, MD, PhD, Associate Professor, Department of Hepatobiliary Surgery, Qilu Hospital of Shandong University, 107 Wenhua Xi Road, Jinan 250012, Shandong Province, China. jinglewei@sdu.edu.cn
Telephone: +86-531-82169203 Fax: +86-531-82169243
Received: July 16, 2017
Peer-review started: July 18, 2017
First decision: August 10, 2017
Revised: August 17, 2017
Accepted: August 25, 2017
Article in press: August 25, 2017
Published online: September 28, 2017
Abstract
AIM

To prospectively evaluate the effect of local wound infiltration with ropivacaine on postoperative pain relief and stress response reduction after open hepatectomy.

METHODS

A total of 56 patients undergoing open hepatectomy were randomly divided into two groups: a ropivacaine group (wound infiltration with ropivacaine solution) and a control group (infiltration with isotonic saline solution). A visual analog scale (VAS) at rest and on movement was used to measure postoperative pain for the first 48 h after surgery. Mean arterial pressure (MAP), heart rate (HR), time to bowel recovery, length of hospitalization after surgery, cumulative sufentanil consumption, and incidence of nausea and vomiting were compared between the two groups. Surgical stress hormones (epinephrine, norepinephrine, and cortisol) were detected using enzyme-linked immunosorbent assay, and the results were compared.

RESULTS

VAS scores both at rest and on movement at 24 h and 48 h were similar between the two groups. Significantly lower VAS scores were detected at 0, 6, and 12 h in the ropivacaine group compared with the control group (P < 0.05 for all). MAP was significantly lower at 6, 12, and 24 h (P < 0.05 for all); HR was significantly lower at 0, 6, 12, and 24 h (P < 0.05 for all); time to bowel recovery and length of hospitalization after surgery (P < 0.05 for both) were significantly shortened; and cumulative sufentanil consumption was significantly lower at 6, 12, 24, and 36 h (P < 0.05 for all) in the ropivacaine group than in the control group, although the incidence of nausea and vomiting showed no significant difference between the two groups. The levels of epinephrine, norepinephrine, and cortisol were significantly lower in the ropivacaine group than in the control group at 24 and 48 h (P < 0.01 for all).

CONCLUSION

Local wound infiltration with ropivacaine after open hepatectomy can improve postoperative pain relief, reduce surgical stress response, and accelerate postoperative recovery.

Keywords: Local wound infiltration, Ropivacaine, Open hepatectomy, Postoperative pain, Surgical stress

Core tip: This study prospectively evaluated the effect of local wound infiltration with ropivacaine on postoperative pain relief and stress response reduction after open hepatectomy. Wound infiltration with ropivacaine could provide more effective analgesia both at rest and on movement in the first 48 h after surgery, with lower mean arterial pressure, heart rate and sufentanil consumption, accelerated postoperative recovery, and reduced stress response. These results suggest that local wound infiltration with ropivacaine is a simple, convenient and effective analgesic method that can provide postoperative analgesia and short-term benefits after open hepatectomy.