Systematic Review and Meta-Analysis of Ropivacaine Usage in Laparoscopic Hysterectomy

Objectives: To assess the efficacy of all forms of ropivacaine administration for the management of pain and opioid use specifically in patients undergoing laparoscopic hysterectomy
Materials: We searched PubMed, Cochrane CENTRAL, Web of Science, and SCOPUS for relevant clinical trials matching our eligibility criteria.
Methods: Outcomes of interest included: Pain intensity (measured either by VAS score or by NRS score), QoR-40 score (Overall quality of recovery tool, designed to measure physical comfort, physical independence, pain, emotional status, and need for support), and the need for opioid rescue. We performed the analysis under the fixed-effects model for homogeneous data and random-effects model for heterogeneous data. We assessed the risk of bias using Cochrane’s risk of bias tool.
Results: A total of five clinical trials were included. Regarding the pain score, there was no significant difference between both groups (SMD = -0.17 [95% CI = -0.56, 0.23]. P = 0.41). The Analysis of overall RoQ40 score favored ropivacaine group over control group significantly (MD = 17.68 [95% CI = 1.48, 33.87]. P = 0.0002). Regarding the use of opioids, the analysis revealed no significant difference between either groups (MD = -2.57 [95% CI = -6.62, 1.49]. P = 0.21).
Conclusion: Ropivacaine administration by any method does not seem to be effective in reducing pain or reducing the need for opioid use after laparoscopic hysterectomy procedures; however, the administration did show a significant improvement in the patient’s “overall quality of recovery” as measured by the QoR-40 tool.