• Robert Baird, Pablo Ingelmo, Andrew Wei, Yash Meghani, Eduardo Vega Perez, Helene Pelletier, Grant Auer, Razaz Mujallid, Sherif Emil, Jean-Martin Laberge, Pramod Puligandla, Kenneth Shaw, and Dan Poenaru.
• Department of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Centre. Electronic address: robert.baird@cw.bc.ca.
• J. Pediatr. Surg. 2019 Jan 1; 54 (1): 33-38.

PurposePostoperative pain remains a considerable concern for patients and families. We assessed whether nebulized ropivacaine reduces morphine consumption and pain after laparoscopic appendectomy for uncomplicated appendicitis in children.MethodsPatients 7-17 years old with uncomplicated appendicitis were randomized to ropivacaine (intervention arm) or saline nebulization (placebo arm) at the onset of laparoscopy. Nonconsenting individuals were treated with standard care and invited to provide clinical data (baseline arm). The primary outcome was in-patient morphine utilization. Secondary outcomes included pain scores at multiple time-points, markers of recovery, operative times, and surgeon satisfaction. The trial was registered (NCT02624089).ResultsStudy enrollment was 116 patients over a 1-year period: Intervention (n = 43), Placebo (n = 39), Baseline (n = 34). No differences in baseline characteristics were noted between groups. No difference was noted in overall in-patient morphine consumption between randomized groups (0.31 vs. 0.35 mg/kg, p = 0.42) or between ropivacaine and baseline (0.31 vs. 0.277 mg/kg, p = 0.62). Although operative times were comparable between groups, 63% of surgeon respondents felt that nebulization obscured visualization.ConclusionNebulized ropivacaine did not reduce postoperative morphine consumption or pain scores after laparoscopic appendectomy for simple appendicitis in children. Given that it decreases visualization and likely increases costs, nebulized administration of intraperitoneal analgesia does not appear warranted in this context.Type Of StudyTreatment study.Level Of EvidenceLevel I.Copyright © 2018 Elsevier Inc. All rights reserved.

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