Costas-Gastiaburo L A, Rajah V, Rubin J
Department of Otolaryngology, University of Natal, Durban.
S Afr J Surg. 1998 Nov;36(4):142-5.
In this prospective double-blind trial, the effect of peritonsillar infiltrations was assessed with regard to intra-operative bleeding and postoperative pain in 100 young adults who underwent elective tonsillectomy under balanced general anaesthesia. Patients were randomly assigned to 1 of 5 groups (20 patients in each group) and received infiltrations as follows: group 1--bupivacaine (0.5%) with adrenaline (1:200,000); group II--bupivacaine (0.5%); group III--normal saline with adrenaline (1:200,000); group IV--normal saline; group V--no infiltration (control group). With regard to blood loss, groups I-IV lost a mean of 47 ml (95% CI = 69.78), while group V lost a mean of 121 ml (95% CI = 78.10) (P = 0.0002). Group V had the highest pain score (average 4.62) measured in recovery, 4 and 24 hours after tonsillectomy (P = 0.0051) and required more narcotic analgesia. Groups II and III had the lowest score (average 1.72) after 24 hours. The bupivacaine group (II) had the highest incidence (71.4%) of nausea and vomiting. Peritonsillar infiltrations decrease intra-operative bleeding and pain, independent of the type of solution infiltrated, by providing a better defined plane of dissection which minimises trauma to the surrounding tissue. Normal saline infiltrations with or without adrenaline should be used since they have no side-effects and are inexpensive and easily available.
在这项前瞻性双盲试验中，对100例在平衡全身麻醉下接受择期扁桃体切除术的年轻成年人，评估了扁桃体周围浸润对术中出血和术后疼痛的影响。患者被随机分为5组（每组20例），并接受如下浸润：第1组——布比卡因（0.5%）加肾上腺素（1:200,000）；第II组——布比卡因（0.5%）；第III组——生理盐水加肾上腺素（1:200,000）；第IV组——生理盐水；第V组——不进行浸润（对照组）。关于失血量，第I - IV组平均失血量为47毫升（95%可信区间 = 69.78），而第V组平均失血量为121毫升（95%可信区间 = 78.10）（P = 0.0002）。第V组在扁桃体切除术后恢复时、4小时和24小时的疼痛评分最高（平均4.62）（P = 0.0051），且需要更多的麻醉性镇痛药。第II组和第III组在24小时后的评分最低（平均1.72）。布比卡因组（第II组）恶心和呕吐的发生率最高（71.4%）。扁桃体周围浸润通过提供更清晰的解剖平面，减少术中出血和疼痛，而与浸润溶液的类型无关，这可使对周围组织的创伤最小化。应使用含或不含肾上腺素的生理盐水浸润，因为它们无副作用，价格低廉且易于获得。
