JOURNAL OF LAPAROENDOSCOPIC & ADVANCED SURGICAL TECHNIQUES Volume 19, Number 6, 2009 © Mary Ann Liebert, Inc. DOI: 10.1089/lap.2008.0227 Efficacy of Periportal Infiltration and Intraperitoneal Instillation of Ropivacaine After Laparoscopic Surgery in Children Maria Rita Di Pace, MD, 1 Marcello Cimador, MD, 1 Pieralba Catalano, MD, 1 Anna Caruso, MD, 1 Maria Sergio, MD, 1 Alessandra Casuccio, MD, 2 and Enrico De Grazia, MD, 1 Abstract Postoperative pain is less intense after laparoscopic than after open surgery. However, minimally invasive sur- gery is not a a pain-free procedure. Many trials have been done in adults using intraperitoneal and/or inci- sional local anesthetic, but similar studies have not yet been reported in the literature in children. Aim: The aim of this study was to evaluate the analgesic effect of periportal infiltration and intraperitoneal in- stillation of ropivacaine in children undergoing laparoscopic surgery. Materials and Methods: Thirty patients who underwent laparoscopic surgery were randomly allocated to one of three groups. Group A (n = 10) received local infiltration of port sites with 10 mL of ropivacaine. Group B (n = 10) received both an infiltration of port sites with 10 mL of ropivacaine and an intraperitoneal instillation of 10 mL of ropivacaine. Group C did not receive any analgesic treatment. The local anesthetic was always ad- ministered at the end of surgery. The degree of postoperative abdominal parietal pain, abdominal visceral pain, and shoulder pain was assessed by using a Wong-Baker pain scale and a Visual Analog Scale (VAS) at 3, 6 12, and 24 hours postoperatively. The following parameters were also evaluated: rescue analgesic treatment, length of hospital stay, and time of return to normal activities. Results: Three hours after operation, patients had low pain scores. Six and 12 hours postoperatively, the ab- dominal parietal pain was significantly higher (P  0.0005) in group C than in the other two groups, both treated with an infiltration at the trocar sites; mean intensity of abdominal visceral pain was significantly lower (P  0.0005) in group B than in groups A and C; the overall incidence of shoulder pain was significantly lower (P  0.0005) in group B patients than in patients of groups A and C. At 20 hours postoperatively, pain scores were significantly reduced of intensity in all groups. Rescue analgesic treatment was significantly higher in group C, if compared to groups A and B 12 hours after the operation. No statistically significant difference was found in length of hospital stay, but children who received analgesic treatment had a more rapid return to normal activities than untreated patients (P  0.0005). Conclusions: Our study demonstrates that the combination of local infiltration and intraperitoneal instillation of ropivacaine is more effective for pain relief in children after laparoscopic surgery than the administration of ropivacaine only at the trocar sites. 821 Introduction P ostoperative pain is less intense after minimally inva- sive surgery than after open surgery. However, laparos- copy is not a pain-free procedure and the management of postlaparoscopy pain remains a major concern. Actually, it has been reported that from 35 to 63% of patients undergo- ing laparoscopic surgery suffer pain, mainly during the first postoperative hours. 1 The origin of pain after laparoscopic procedures is multifactorial, with pain arising from the inci- sional trauma at port sites, the distention and chemical irri- tation of the peritoneum, the diaphragmatic stretching with phrenic nerve neuropraxia, and direct tissue injury. 2–4 Many trials have been done in adults using intraperitoneal and/or incisional local anesthetic, but, to our knowledge, similar studies have not yet been reported in the literature in pedi- Pediatric Surgical Unit, Departments of 1 Mother and Child Care and 2 Clinical Neuroscience, Università di Palermo, Palermo, Italy.