Comparative Study Between Different Routes of Ropivacaïne Administration to Reduce Post-operative Pain in Gynecological Laparoscopy, a Double Blind Randomized Trial.

Research Question What is the best route of Ropivacaine administration in laparoscopic procedures in decreasing post-operative pain? Is it port site injection, intra-peritoneal instillation of local anesthetics or is it a combination of both routes? Our hypothesis is that a combination of port site injection and intra-peritoneal instillation of local anesthetics will be more effective in lowering pain the first 24 hours after surgery.

3. Characteristics of the patient population Inclusion criteria

4. Elective gynecologic laparoscopy for benign conditions at Antwerp University Hospital.

5. Successful laparoscopy without surgical or anesthetic complications.

6. Female

7. 18-70 years

8. ASA( American Society of Anesthesia) I-II Exclusion criteria

(1) Hypersensitivity to anaesthetics of the amide-type (2) Obesity, BMI > 35 (3) Patients with chronic use of analgesics / chronic pain (4) Patients with an abnormal liver function (5) Urgent surgical procedures (6) Pregnancy (this means we only include patients who use contraceptives, are sterilized, have a negative dipstick testing or a negative serum testing or patients who are postmenopausal) 4. Characteristics of the treatment We will be using ropivacaine - naropin 7,5mg/ml, a local anaesthetic of the amide type. The administered dose of this local anaesthetic will be 3mg/kg for each patient. Depending on the study group the patient belongs to, this dose will be given in full by either local injection at the trocar entry points or by intraperitoneal injection or it will be divided between both injection sites, respectively 1mg at the trocar sites and 2mg intraperitoneal. The unequal dose distribution is based on the surface area the local anaesthetic has to cover.

5. Methodology Anaesthetic management will be standardized for each person. The anaesthetist will insert an intravenous line and connect the patient to the monitor. We will be using routine intraoperative monitoring devices such as an electrocardiograph, a pulse oximetry and a non-invasive blood pressure monitor. The patient is preoxygenated with 100% O2 before induction.