Effect of local wound infiltration with ropivacaine on postoperative pain relief and stress response reduction after open hepatectomy

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 and48 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.

Overlay of a sponge soaked with ropivacaine and multisite infiltration analgesia result in faster recovery after laparoscopic hepatectomy

BACKGROUND Compared with traditional open surgery,laparoscopic surgery is preferred due to the advantages of less trauma,less pain,and faster recovery.Nevertheless,many patients still suffer from postoperative pain resulting from the surgical incision and associated tissue injury.Many researchers have reported methods to improve postoperative pain control,but there is not a simple and effective method that can be clinically adopted in a widespread manner.We designed this study to prove the hypothesis that application of ropivacaine in the port site and operative site in patients is an effective and convenient method which can decrease postoperative pain and accelerate recovery.AIM To evaluate the effects of ropivacaine on pain control after laparoscopic hepatectomy and its contribution to patient recovery.METHODS From May 2017 to November 2018,146 patients undergoing laparoscopic hepatectomy were randomized to receive infiltration of either 7.5 mg/mL ropivacaine around the trocar insertions,incision,and cutting surface of the liver(with a gelatin sponge soaked with ropivacaine)at the end of surgery(ropivacaine group),or normal saline(5 mL)at the same sites at the end of surgery(control group).The degree of pain,nausea,vomiting,heart rate(HR),and blood pressure were collected.The length of postoperative hospitalization,complications,and the levels of stress hormones were also compared between the two groups.RESULTS Compared with the control group,the ropivacaine group showed reduced postoperative pain at rest within 12 h(P<0.05),and pain on movement was reduced within 48 h.The levels of epinephrine,norepinephrine,and cortisol at 24 and 48 h,HR,blood pressure,and cumulative sufentanil consumption in the ropivacaine group were significantly lower than those in the control group(P<0.05).In the ropivacaine group,hospitalization after operation was shorter,but the difference was not statistically significant.There were no significant differences in postoperative nausea,vomiting,or other complications,including hydrothorax,ascites,peritonitis,flatulence,and venous thrombus(P>0.05),although fewer patients in the ropivacaine group experienced these situations.CONCLUSION Infiltration with ropivacaine in the abdominal wound and covering the cutting surface of the liver with a gelatin sponge soaked with ropivacaine significantly reduce postoperative pain and the consumption of sufentanil.

Analgesic effect of parecoxib combined with ropivacaine in patients undergoing laparoscopic hepatectomy

BACKGROUND Currently, there is no uniform standard for analgesia during laparoscopic hepatectomy. Most of the analgesia schemes adopt epidural analgesia after laparotomy. Although the analgesia is effective, it has a great impact on the recovery of patients after laparoscopic hepatectomy and is not completely suitable for analgesia after laparoscopic hepatectomy. Although multimodal perioperative analgesia can significantly relieve postoperative pain, there is no relevant study of parecoxib combined with ropivacaine for post-laparoscopic hepatectomy analgesia. AIM To study the analgesic effect of the preoperative intravenous injection of parecoxib combined with long-acting local anesthetic ropivacaine for incision infiltration in patients undergoing laparoscopic hepatectomy. METHODS Forty-eight patients undergoing laparoscopic hepatectomy were randomly divided into a combined group (parecoxib combined with ropivacaine) and a control group. The visual analogue scale (VAS) at rest and during movement was used to compare the analgesic effect of the two groups. Meanwhile, the cumulative sufentanil, the recovery time for enterokinesia, the length of postoperative hospital stay, and the adverse reactions (nausea and vomiting) were recorded and compared between the two groups.The change tendency in VAS scores for both groups was similar after operation. At rest, the VAS scores of the combined group were significantly lower than those of the control group at 0, 6, 12, 24 and 36 h, and during movement, the VAS scores of the combined group were significantly lower than those of the control group at 0, 6, 12, and 24 h. The recovery time for enterokinesia in the combined group was 2.9 d, which was significantly shorter than that in the control group. The cumulative sufentanil in the combined group decreased significantly at 24, 36, and 48 h after operation. CONCLUSION Preoperative intravenous injection of parecoxib combined with ropivacaine for incision infiltration is a simple and effective method for postoperative analgesia in laparoscopic hepatectomy, which could relieve pain and promote recovery.

Effects of Ropivacaine and Bupivacaine on Rabbit Myocardial Energetic Metabolism and Mitochondria Oxidation

To compare the cardiotoxicity induced by ropivacaine and bupivacaine and to investigate the mechanism of cardiotoxicity, 24 mature New Zealand rabbits were divided randomly into control group (group C), ropivacaine group (group R) and bupivacaine group (group B). Hearts were drawn out rapidly from the anesthetized animals and cardiac perfu-sion was performed immediately. Ropivacaine 500 ng/ml (group R) or bupivacaine 500 ng/ml (group B) was added to the perfusion solution. Ventricular myocardial ATP, ADP and AMP were measured with high performance liquid chro-matogram. The ability of myocardial mitochondria oxidation to pyruvate or palmitoylcarnitine was detected with Clark electrode. Our results showed that myocardial ATP and ADP decreased significantly (P<0. 05) in group R and most significantly (P<0. 01) in group B as compared with group C. Myocardial ATP and ADP decreased most significantly (P<0. 01) in group B as compared with group R. The changes of myocardial AMP revealed significant difference among three groups. The changes of pyruvate oxidation exibited no significant difference among the three groups. Palmitoylcarnitine oxidation decreased markedly (P<0. 05) in group R and most significantly (P<0. 01) in group B as compared with group C. The present study indicated that the inhibition of lipid substrate oxidation may be responsible for the cardiotoxicity induced by bupivacaine and ropivacaine. The cardiotoxicity induced by ropivacaine is far more less than bupivacaine.

Effects of Ropivacaine-sufentanil Epidural Analgesia on Labor and Maternal and Neonatal Outcomes

[Objectives]This study aimed to investigate the effects of ropivacaine-sufentanil epidural analgesia on labor and maternal and neonatal outcomes.[Methods]A total of 180 primiparas in full-term pregnancy were selected.They were randomly divided into treatment group(n=90)and control group(n=90).The primiparas in the treatment group were injected epidurally with ropivacaine and sufentanil for analgesia,and the primiparas in the control group were subjected to vaginal delivery.The VAS scores at 5,10,30 and 60 min of analgesia were observed.The vaginal bleeding amount,total labor duration,neonatal Apgar score and vaginal delivery rate of the two groups were compared.[Results]Compared with the control group,the VAS score in the treatment group differed insignificantly after 5 min of analgesia(P>0.05),and decreased significantly after 10,30 and 60 min of analgesia(P<0.05).The vaginal bleeding amount of the treatment group was significantly smaller than that of the control group(P<0.05).There was no significant difference in the neonatal Apgar score between the two groups(P>0.05).In the treatment group,the vaginal delivery rate increased(P<0.05),the second stage of labor was prolonged(P<0.05),and the first and third stages of labor did not change significantly(P>0.05).[Conclusions]Epidural analgesia with ropivacaine and sufentanil has a good analgesic effect and good safety,and is worthy of clinical promotion.

Continuous Intra-Articular Ropivacaine/Tramadol Combination Infusion Therapy Improves Postoperative Outcome of Total Knee Arthroplasty

Objectives: To evaluate the postoperative analgesic yield of continuous intra-articular (IA) ropivacaine/tramadol infusion as against infusion of ropivacaine alone after total knee arthroplasty. Patients and Methods: Sixty patients accompanied by arthrosis were randomly divided into three equal groups: The ropivacaine group, which obtained a continuous intraarticular (IA) infusion of ropivacaine alone;the combination group, which obtained a continuous (IA) infusion of a combination of ropivacaine and tramadol at a rate of 6 ml/h for 72 h postoperatively;and the control group, which did not receive IA medications. After release of the ischemic tourniquet and assurance of haemostasis, a vacuum drainage tube was applied. The (IA) infusion was delivered through a multipored catheter for 72 h. Postoperative pain was assessed using visual analogue pain scale (VAS), and intravenous meperidine was administered as rescue analgesia if the (VAS) pain score was greater than or equal to (4) or on patient’s request. The total rescue analgesia consumption, angle of flexion of the knee and hospital stay were recorded. Results: The ability to achieve better angle of flexion was significantly higher in the combination group compared with the other groups, with a significant difference in favour of the ropivacaine group compared with the control group. At 2 h postoperatively, the mean pain (VAS) scores were significantly lower in patients who received (IA) analgesia compared with the control group and in the ropivacaine/tramadol group versus the ropivacaine group. The number of requests and total dose of rescue analgesia consumed were significantly lower with (IA) analgesia, with a significant difference in favour of the combination group. There was significant correlation between pain (VAS) scores and angle of flexion of the knee joint. Conclusion: Continuous (IA) ropivacaine/tramadol infusion safely reduced postoperative pain and spared administration of rescue analgesics with a significantly improved range of joint movement.

Efficacy and safety of different doses of ropivacaine + sufentanil for epidural labor analgesia

Objective:To study the efficacy and safety of different doses of ropivacaine and sufentanil for epidural labor analgesia.Methods: The primiparae with single birth and cephalic presentation who underwent vaginal delivery in Chengde Maternal and Child Health Hospital between March 2015 and February 2018 were selected and randomly divided into the group A who received subarachnoid injection of sufentanil 4 μg, the group B who received injection of sufentanil 4 μg + ropivacaine 2 mg and the group C who received injection of sufentanil 4 μg+ ropivacaine 3 mg. During childbirth, serum was collected at the first, second and third stages of labor respectively to detect the secretion of pain mediators and oxidative stress mediators;after childbirth, the placenta was collected to determine the expression of stress molecules. Results: At first, second and third stages of labor, serum SP, DYN, NE, PGE2, TNF-α, COR, AT-II and MDA secretion of group B and group C were significantly lower than those of group A whereas SOD and GSH-Px secretion were significantly higher than those of group A, and serum SP, DYN, NE, PGE2, TNF-α, COR, AT-II and MDA secretion of group C were significantly lower than those of group B whereas SOD and GSH-Px secretion were significantly higher than those of group B;after childbirth, GRP78, CHOP, Bax and Caspase-3 mRNA expression in placenta of group B and group C were significantly lower than those of group A whereas Bcl-2 mRNA expression were significantly higher than that of group A, and GRP78, CHOP, Bax and Caspase-3 mRNA expression in placenta of group C were significantly lower than those of group B whereas Bcl-2 mRNA expression was significantly higher than that of group B.Conclusion: The analgesic effect of sufentanil 4 μg + ropivacaine 3 mg for epidural labor analgesia is the most significant.

Comparison of Parasternal Intercostal Block Using Ropivacaine or bupivacaine for Postoperative Analgesia in Patients Undergoing Cardiac Surgery

Objective: The objective of this study was to compare the efficacy of 0.5% ropivacaine and 0.25% bupivacaine for parasternal intercostal block for postoperative analgesia in children undergoing cardiac surgery. Design: A randomized, controlled, prospective, double blind study. Setting: A tertiary care teaching hospital. Participants: One Hundred children scheduled for cardiac surgery through a median sternotomy were divided into 3 groups of at least 33 children each, receiving either ropivacaine, bupivacaine or saline (control). Interventions: A bilateral parasternal block performed either with 0.5% ropivacaine or 0.25% bupiacaine or 0.9% saline with 5 doses of 0.5 mL on each side in the 2nd to 6th parasternal intercostal spaces 1 to 1.5 cm lateral to the sternal edge, before sternal wound closure. Measurements and Main Results: The time to extubation was significantly less in children administered the parasternal blocks with ropivacaine or bupivacaine compared to the saline (control) group. The pain scores were lower and comparable in the ropivacaine and bupivacaine groups compared to the saline group. The cumulative fentanyl dose requirement over a 24-hour period was higher in the saline group than the ropivacaine (p < 0.001) and bupivacaine group. No side effects were observed in any of the children. Conclusions: Parasternal blocks either with ropivacaine or bupivacaine appear to be a simple, safe, and useful technique for supplementation of postoperative analgesia in children undergoing cardiac surgery with a median sternotomy.

Locoregional Anesthesia in a Resource-Limited Country: Can Lidocaine 1.5% with Adrenaline Be an Alternative to Ropivacaine 0.5% for Ultrasound-Guided Axillary Blocks?

Background: The ultrasound-guided axillary block is a block commonly used in upper limb surgery. Several local anaesthetics can be used to obtain an effective block. These include ropivacaine 0.5% and lidocaine 1.5% with adrenaline. Objective: To evaluate lidocaine 1.5% with adrenaline as an alternative to ropivacaine 0.5% for ultrasound-guided axillary blocks. Methodology: This was a 6-month prospective and randomized study (July 15, 2019 to January 15, 2020) conducted in the Department of Anesthesia at Ignace Deen National Hospital in Conakry, Guinea. Results: A total of 38 patients were enrolled: 19 in each group. The mean age was 45.8 ± 16.9 years in the lidocaine with adrenaline group compared to 43.9 ± 20 years in the ropivacaine group. The mean onset time in the lidocaine group was 6.8 ± 2.1 minutes compared to 8.3 ± 2.4 minutes in the ropivacaine group (p = 0.04). The mean duration of axillary block was 233.3 ± 57.5 minutes in the lidocaine group versus 260.4 ± 74 minutes in the ropivacaine group (p = 0.21). The performance was identical in both groups with 89.5% of the effective blocks in the lidocaine group and in the ropivacaine group (p = 1). The cost of consumables for the ropivacaine group was 60 euros compared to 15 euros for the lidocaine group. Conclusion: Lidocaine 1.5% with adrenaline is a good alternative to ropivacaine 0.5% for ultrasound-guided axillary blocks in resource-limited countries.

Efficacy of low-dose fentanyl and ropivacaine combined spinal-epidural anesthesia for labor analgesia

Objective: To study the efficacy of low-dose fentanyl and ropivacaine combined spinal-epidural anesthesia for labor analgesia. Methods: Puerperae who underwent vaginal delivery under combined spinal-epidural anesthesia for labor analgesia in Lincheng People's Hospital between June 2014 and March 2017 were selected and randomly divided into three groups, group A received 15 μg small-dose fentanyl and ropivacaine combined spinal-epidural anesthesia for labor analgesia, group B received 25 μg large-dose fentanyl and ropivacaine combined spinal-epidural anesthesia for labor analgesia, and group C received ropivacaine epidural anesthesia alone for labor analgesia. During delivery, the serum in the second stage of labor was collected to determine the contents of pain transmitters, inflammatory cytokines and stress response indexes. Results: During delivery, serum SP, 5-HT, DA, NE, DYN, TNF-α, IL-1β, IL-6, IL-10, PGE2, Cor, C-P, MDA and AOPP contents of group A and group B were lower than those of group C and serum SP, 5-HT, DA, NE, DYN, TNF-α, IL-1β, IL-6, IL-10, PGE2, Cor, C-P, MDA and AOPP contents of group A were not significantly different from those of group B. Conclusion: 15 μg small-dose fentanyl and ropivacaine combined spinal-epidural anesthesia for labor analgesia is with exact efficacy and good safety.

Comparison of dexmedetomidine and fentanyl as adjuvants for ropivacaine for epidural anesthesia:a Meta-analysis of randomized controlled trial

Objective:To systematically review the efficacy of dexmedetomidine and fentanyl as adjuvants for ropivacaine for epidural anesthesia.Methods:We searched the Cochrane Library,PubMed,Embase,CNKI,VIP,WanFang Database,search time from the year of construction to December 2018 for all randomized controlled trials(RCTs)about the efficacy of dexmedetomidine versus fentanyl as adjuvants for ropivacaine for epidural anesthesia.The quality of the studies evaluated by the method recommended by Cochrane Collaboration.Meta-analysis was conducted using the Cochrane Collaboration's RevMan 5.3 software.Results:Eight RCTs involving 592 Patients were included in our Meta-analysis.The results of meta-analysis showed that compared with fentanyl,dexmedetomidine can reduce the incidence of postoperative nausea and vomiting in patients with ropivacaine epidural anesthesia[OR=0.43,95%CI(0.29,0.66),P<0.0001]and the incidence of post-cold[OR=0.34,95%CI(0.18,0.63),P<0.0001],accelerated onset of analgesia[MD=-2.78,95%CI(-4.81,-0.75),P<0.0001],prolonged time of analgesia[MD=99.04,95%CI(82.73,115.34),P<0.0001],enhanced sedation in non-cesarean section[MD=1.01,95%CI(0.87,1.15),P<0.0001],but increased the incidence of dry mouth[OR=5.63,95%CI(2.85,11.10),P<0.0001],shortening the duration of nerve block[MD=-4.35,95%CI(-7.31,-1.40),P<0.0001],sedation was not as good as fentanyl in cesarean section[MD=-0.89,95%CI(-1.39,-0.38),P<0.0001].Conclusion:Available evidence suggests that dexmedetomidine,as an adjuvant for ropivacaine for epidural anesthesia,has a better analgesic effect than fentanyl,and can reduce the incidence of nausea,vomiting,and chills,but should pay attention to its risk of dry mouth and the sedative effect on different operations.

Evaluation of Light Specific Gravity Ropivacaine Combined with Sufentanil in Hip Arthroplasty at An Advanced Age

combined with sufentanil in elderly patients undergoing hip replacement.Methods:89 elderly patients with hip arthroplasty from July 2019 to September 2020 were randomly divided into experimental group and control group.The experimental group was anesthetized with light specific gravity ropivacaine combined with sufentanil.The control group was anesthetized with equal specific gravity ropivacaine to compare the effect of anesthesia and the incidence of adverse reactions.Results:there was no significant difference in sensory recovery time and motor recovery time between the experimental group and the control group(P>0.05),and the incidence of adverse reactions between the two groups was low.The sensory block time in the experimental group was shorter than that in the control group(PP>0.05).Conclusion:ropivacaine combined with sufentanil subarachnoid anesthesia is more effective in elderly patients undergoing hip arthroplasty,and the safety of the anesthesia scheme is higher,which will not lead to serious adverse reactions during operation.Moreover,the application of the anesthesia scheme can effectively improve the analgesic effect during and after operation,and the clinical application value is high.

Evaluation of the efficacy of ropivacaine combined with sufentanil and ropivacaine alone for epidural labor analgesia

Objective: To study the efficacy of ropivacaine combined with sufentanil and ropivacaine alone for epidural labor analgesia. Methods: Primiparae who received vaginal delivery under epidural analgesia in Ankang People's Hospital between March 2015 and February 2017 were selected and randomly divided into accepting the group A who received ropivacaine combined with sufentanil for epidural analgesia and the group B who received ropivacaine alone for epidural analgesia. During the first, the second and the third stage of labor, the serum was collected to determine the levels of pain mediators SP, 5-HT and PGE2 as well as stress hormones NE, E, F-C, AT-II and INS;after delivery, the placenta tissue was collected to determine the expression of stress molecules GRP78, CHOP, Nrf-2 and ARE. Results: Serum SP, 5-HT, PGE2, NE, E, F-C, AT-II and INS levels of group A during the first, the second and the third stage of labor were significantly lower than those of group B;GRP78, CHOP, Nrf-2 and ARE mRNA expression in placental tissue of group A after delivery were significantly lower than those of group B. Conclusion: ropivacaine combined with sufentanil for epidural labor analgesia is more effective than ropivacaine alone in reducing pain and inhibiting stress response.

Effect of nalbuphine preemptive analgesia combined with ropivacaine local infiltration on postoperative incision pain,stress response and immune function in children

Objective: To study the effect of nalbuphine preemptive analgesia combined with ropivacaine local infiltration on postoperative incision pain, stress response and immune function in children. Methods: Children who received selective laparotomy in Mianyang Central Hospital between August 2015 and August 2017 were selected and randomly divided into control group, nalbuphine group (N group), ropivacaine group (R group) and nalbuphine + ropivacaine group (N+R group). The levels of pain and stress-related mediators in serum and the levels of immune cells in peripheral blood were detected before operation and 24 h after operation. Results: 24 h after operation, serum Cor, NE, MDA, SP, PGE2, BK, NPY, TNF-α, IL-6 and IL-10 levels of four groups of children were significantly higher than those before operation while serum SOD and CAT levels as well as peripheral blood CD3+, CD4+ and CD8+T cell levels were significantly lower than those before operation;serum Cor, NE, MDA, SP, PGE2, BK, NPY, TNF-α, IL-6 and IL-10 levels of N group, R group and N+R group were significantly lower than those of control group while serum SOD and CAT levels as well as peripheral blood CD3+, CD4+ and CD8+T cell levels were significantly higher than those of control group;serum Cor, NE, MDA, SP, PGE2, BK, NPY, TNF-α, IL-6 and IL-10 levels of N+R group were significantly lower than those of N group and R group while serum SOD and CAT levels as well as peripheral blood CD3+, CD4+ and CD8+T cell levels were significantly higher than those of N group and R group. Conclusion: Nalbuphine preemptive analgesia combined with ropivacaine local infiltration can reduce the postoperative incision pain and stress response and improve the immune function in children.

Effect of ropivacaine combined with sufentanil epidural labor analgesia on pain neurotransmitters as well as cytokine production and stress hormone secretion

Objective: To discuss the effect of ropivacaine combined with sufentanil epidural labor analgesia on pain neurotransmitters as well as cytokine production and stress hormone secretion. Methods: A total of 218 cases of puerperae who received caesarean section in the hospital between January 2015 and January 2017 were divided into control group (n=109) and observation group (n=109) by random table method. Control group received postpartum ropivacaine epidural analgesia alone, and observation group received postpartum ropivacaine combined with sufentanil epidural analgesia. The differences in serum levels of pain neurotransmitters, inflammatory factors and stress hormones were compared between the two groups immediately after childbirth (T0), 6 h after delivery (T1), 12 h after delivery (T2) and 24 h after delivery (T3). Results: At T0, the differences in serum levels of pain neurotransmitters, inflammatory factors and stress hormones were not statistically significant between the two groups. At T1, T2 and T3, serum NPY, β-EP and SP levels of observation group were lower than those of control group at corresponding points in time;serum IL-1β, hs-CRP and IL-6 levels of observation group were lower than those of control group at corresponding points in time;serum Cor, AngⅠ, AngⅡ and NE levels of observation group were lower than those of control group at corresponding points in time. Conclusion:Ropivacaine combined with sufentanil epidural analgesia after caesarean section can effectively inhibit the pain neurotransmitter expression and relieve the systemic inflammatory stress response in puerperae.

Application of inflation fluid containing ropivacaine hydrochloride in endoscopic thyroidectomy on stress response and pain mediators

Objective:To study the effect of the application of inflation fluid containing ropivacaine hydrochloride in endoscopic thyroidectomy on stress response and pain mediators. Methods:128 patients receiving endoscopic thyroidectomy in our hospital between November 2015 and November 2016 were selected and randomly divided into two groups (n=64), observation group of patients received the inflation fluid containing ropivacaine hydrochloride as the inflating medium during endoscopic thyroidectomy and control group of patients received saline inflation fluid as the inflating medium during endoscopic thyroidectomy. Serum was collected before and after operation respectively to determine the levels of stress response-related hormones and pain-related mediators. Results:Serum adrenocorticotropic hormone (ACTH), cortisol (Cor), norepinephrine (NE), epinephrine (E), renin (PRA), angiotensin-2 (ANG-2), aldosterone (ALD), dynorphin (DYN),β-endorphin (β-EP), nitric oxide (NO) and substance P (SP) levels of both groups after operation were significantly higher than those before operation (P<0.05), and serum ACTH, Cor, NE, E, PRA, ANG-2, ALD, DYN,β-EP, NO and SP levels of observation group after operation were significantly lower than those of control group (P<0.05). Conclusions:The application of inflation fluid containing ropivacaine hydrochloride in endoscopic thyroidectomy can reduce the postoperative stress response and suppress pain mediator secretion.

Effect of continuous spinal anesthesia with ropivacaine on the ultrastructure of spinal cord and nerve roots in rats

To investigate the effects of continuous spinal anesthesia with different concentrations and doses of ropivacaine on the ultrastructure of the spinal cord and nerve roots.Methods Twenty-four male SD rats weighing 220～280 g were anesthetized with intraperitoneal 10% chloral hydrate 300～350 mg/kg.A polyurethane microcatheter was inserted into the lumbar subarachnoid space according to the technique described by Yaksh.An 8 cm catheter segment was left in the subarachnoid space.The animals were randomized to receive normal saline,0.5%,0.75% or 1.0% ropivacaine 40 μl intrathecally 3 times at 1.5 h interval.Six hours after the first intrathecal administration the animals were decaptiated and L 1,2 segment of the spinal cord and nerve roots were immediately removed for electron microscopic examination.Results Electron microscopic examination revealed that in animals which received intrathecal (i.t.) normal saline,0.5% or 0.75% ropivacaine the neurolemma of the nerve roots and the mitochondria and endoplasmic reticulum of the neurons in the spinal cord were intact,while in animals which received i.t. 10.% ropivacaine the neurolemma was stratified and partly disrupted and there were swelling of endoplasmic reticulum and vacuole degeneration.Conclusion Six hours continuous spinal anesthesia with 10.% ropivacaine may be injurious to the spinal cord and nerve roots.12 refs,8 figs,1 tab.

Effect of implanting fibrin sealant with ropivacaine on pain after laparoscopic cholecystectomy

AIM:To investigate the safety and efficacy of implant-ing fibrin sealant with sustained-release ropivacaine in the gallbladder bed for pain after laparoscopic chole-cystectomy(LC).METHODS:Sixty patients(American Society of Anes-thesiologists physical status wasⅠorⅡand underwent LC)were randomly divided into three equal groups:group A(implantation of fibrin sealant in the gallbladder bed),group B(implantation of fibrin sealant carrying ropivacaine in the gallbladder bed),and group C(normal saline in the gallbladder bed).Postoperative pain was evaluated,and pain relief was assessed by visual analog scale(VAS)scoring.RESULTS:The findings showed that 81.7%of patients had visceral pain,50%experienced parietal,and 26.7% reported shoulder pain after LC.Visceral pain was significantly less in group B patients than in the other groups(P<0.05),and only one patient in this group experienced shoulder pain.The mean VAS score in group B patients was lower than that in the other groups.CONCLUSION:Visceral pain is prominent after LC and can be effectively controlled by implanting fibrin sealant combined with ropivacaine in the gallbladder bed.

Local anesthesia with ropivacaine for patients undergoing laparoscopic cholecystectomy

AIM:To investigate the effect of pain relief after infu-sion of ropivacaine at port sites at the end of surgery.METHODS:From October 2006 to September 2007,72 patients undergoing laparoscopic cholecystectomy(LC) were randomized into two groups of 36 patients.One group received ropivacaine infusion at the port sites at the end of LC and the other received normal saline.A visual analog scale was used to assess postoperative pain when the patient awakened in the operating room,6 and 24 h after surgery,and before discharge.The amount of analgesics use was also recorded.The demographics,laboratory data,hospital stay,and perioperative complications were compared between the two groups.RESULTS:There was no difference between the two groups preoperatively in terms of demographic and lab-oratory data.After surgery,similar operation time,blood loss,and no postoperative morbidity and mortality were observed in the two groups.However,a significantly lower pain score was observed in the patients undergo-ing LC with local anesthesia infusion at 1 h after LC and at discharge.Regarding analgesic use,the amount of meperidine used 1 h after LC and the total used during admission were lower in patients undergoing LC with local anesthesia infusion.This group also had a shorter hospital stay.CONCLUSION:Local anesthesia with ropivacaine at the port site in LC patients signif icantly decreased post-operative pain immediately.This explains the lower meperidine use and earlier discharge for these patients.