• Reg Anesth Pain Med · Sep 2009

    Controlled Clinical Trial

    Parietal analgesia decreases postoperative diaphragm dysfunction induced by abdominal surgery: a physiologic study.

    • Marc Beaussier, Hanna El'ayoubi, Maxime Rollin, Yann Parc, Arthur Atchabahian, Gerald Chanques, Xavier Capdevila, André Lienhart, and Samir Jaber.
    • Department of Anesthesia and Intensive Care, St-Antoine Hospital, APHP Université Pierre et Marie Curie, Paris, France. marc.beaussier@sat.aphp.fr
    • Reg Anesth Pain Med. 2009 Sep 1;34(5):393-7.

    Background And ObjectivesThe postoperative analgesic strategy may influence the magnitude of the postoperative diaphragmatic dysfunction (PODD) induced by abdominal surgery. The purpose of this physiologic study was to evaluate the effect of continuous preperitoneal wound infusion (CPWI) of ropivacaine on PODD after open colorectal surgery.MethodsTwenty patients with American Society of Anesthesiologists physical status I or II undergoing open colorectal surgery were prospectively included during 2 consecutive 2-month periods. During the first period, we evaluated 10 consecutive patients who received conventional parenteral analgesia (intravenously administered morphine via patient-controlled analgesia and acetaminophen) without parietal analgesia (control group). These patients were compared with 10 consecutive patients who received conventional parenteral analgesia along with parietal analgesia using CPWI of 0.2% ropivacaine at 10 mL/hr for 48 hrs (CPWI group). Diaphragmatic function was assessed preoperatively and at 24 and 48 hrs postoperatively using the sniff nasal inspiratory pressure test (Psniff). Supplemental intravenously administered morphine boluses were administered as needed before Psniff assessments in the control group to reduce differences in pain intensity.ResultsDemographic and surgical data did not differ between the 2 groups, nor did preoperative Psniff values (71 cm H2O [SD, 20 cm H2O] vs 65 cm H2O [SD,15 cm H2O] in the control and CPWI groups, respectively). Postoperative Psniff was significantly decreased in the 2 groups, but the reduction was significantly greater in the control group than in the CPWI group both at 24 hrs (-58% [SD, 18%] vs -24% [SD, 19%]; P = 0.001) and at 48 hrs (-44% [SD, 31%] vs -11% [SD, 32%]; P = 0.027).ConclusionsParietal analgesia delivered via a CPWI of ropivacaine reduces PODD induced by open colorectal surgery.

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