Effects of negative-pressure therapy with and without ropivacaine instillation in the early evolution of severe peritonitis in pigs
The abdomen is the second most common source of sepsis and secondary peritonitis, which likely lead to death. In the present study, we hypothesized that instillation of local anesthetics into the peritoneum might mitigate the systemic inflammatory response syndrome (SIRS) in the open abdomen when combined with negative-pressure therapy (NPT) to treat severe peritonitis.
We performed a study in 21 pigs applying a model of sepsis based on ischemia/reperfusion and fecal spread into the peritoneum. The pigs were randomized into three groups, and treated for 6 h as follows: Group A: temporary abdominal closure with ABTHERA™ Open Abdomen Negative-Pressure Therapy; Group B: temporary abdominal closure with ABTHERA™ Open Abdomen Negative-Pressure Therapy plus abdominal instillation with physiological saline solution (PSS); and Group C: temporary abdominal closure with ABTHERA™ Open Abdomen Negative-Pressure Therapy plus peritoneal instillation with a solution of ropivacaine in PPS.
A comparison between the three groups revealed no statistically significant difference for any of the parameters registered (p > 0.05), i.e., intra-abdominal pressure, blood pressure, heart rate, O2 saturation, diuresis, body temperature, and blood levels of interleukin 6 (IL-6), tumor necrosis factor alpha (TNFα), and c-reactive protein (CRP). In addition, histological studies of the liver, ileum, kidney and lung showed no difference between groups.
The use of abdominal instillation (with or without ropivacaine) did not change the effect of 6 h of NPT after sepsis in animals with open abdomen. The absence of adverse effects suggests that longer treatments should be tested.
KeywordsSepsis Peritonitis Temporary abdominal closure Negative-pressure therapy Instillation Septic open abdomen
This research received a specific grant from Acelity/KCI, San Antonio, TX, USA.
Compliance with ethical standards
Conflict of interest
Montiel Jiménez-Fuertes is an advisory-board member of Acelity/KCI, contributing research and expertise. All other authors declare that they have no conflict of interest.
This study was approved by the Ethics Committee of Instituto de Investigación Sanitaria de la Fundación Jiménez-Díaz and by the Ethics Committee for Animal Research of Biomedical Research Institute of Lleida (IRBLleida, Spain).
All applicable international, national, and institutional guidelines for the care and use of animals were followed in this study. All procedures performed were in accordance with the ethical standards of the institution where the studies were conducted (IRBLleida, Spain).
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