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A Randomized Controlled Pilot Study of Topical Ropivacaine for Prevention of Post-POEM Pain.

Authors :
Rai M
Nazarin A
Taylor C
McMullen M
Hookey L
Chung W
Bechara R
Source :
Journal of the Canadian Association of Gastroenterology [J Can Assoc Gastroenterol] 2022 Mar 16; Vol. 5 (5), pp. 221-225. Date of Electronic Publication: 2022 Mar 16 (Print Publication: 2022).
Publication Year :
2022

Abstract

Background and Aims: Although usually mild to moderate in severity, postoperative pain after peroral endoscopic myotomy (POEM) is common. There are no studies that have addressed minimizing postoperative pain in patients undergoing POEM for achalasia. We hypothesized that intraoperative topical intra-tunnel irrigation with ropivacaine would result in a significant reduction in pain scores in the postoperative period.<br />Methods: A double-blind, randomized, placebo-controlled trial was conducted at the Kingston Health Sciences Center. Patients received either 30 mL of 0.2% ropivacaine or 30 mL of placebo irrigated topically into the POEM tunnel after completing the myotomy and prior to closing the mucosal incision. The primary outcome was pain post-POEM at 6 h assessed by the Numeric Rating Scale (NRS). Secondary objectives included assessing pain score at 0.5, 1, 2, 4 h post-POEM and on discharge, Quality of Recovery (QoR-15) scores at discharge, narcotic requirement, adverse events, and patients' willingness to have the procedure done on an outpatient basis.<br />Results: A total of 20 patients were enrolled. For the primary outcome of pain post-POEM at 6 h, the NRS was 1.1 in the placebo group and 2.4 in the ropivacaine group (95% CI of the difference: -3.2 to 0.6, P = 0.171). No statistical difference was seen in the pain scores. Overall usage of post-procedural narcotics was low with no differences between the two groups. Fifty percent of patients in both groups were willing to have the procedure done as an outpatient.<br />Conclusion: The addition of intra-procedural tunnel irrigation with 30 mL 0.2% ropivacaine did not lead to reduced post-POEM pain.<br /> (© The Author(s) 2022. Published by Oxford University Press on behalf of the Canadian Association of Gastroenterology.)

Details

Language :
English
ISSN :
2515-2092
Volume :
5
Issue :
5
Database :
MEDLINE
Journal :
Journal of the Canadian Association of Gastroenterology
Publication Type :
Academic Journal
Accession number :
36196273
Full Text :
https://doi.org/10.1093/jcag/gwac007