Kristensen B B, Christensen D S, Ostergaard M, Skjelsager K, Nielsen D, Mogensen T S
Department of Anesthesiology, Hvidovre University Hospital, Copenhagen, Denmark.
Reg Anesth Pain Med. 1999 Nov-Dec;24(6):576-80. doi: 10.1016/s1098-7339(99)90052-4.
It is well known that wound infiltration with local anesthetic can reduce postoperative pain in various degrees and with very few side effects. A previous study showed better analgesic effect when local anesthetic was applied in the subfascial, rather than the subcutaneous, layer. The present study investigated the effect of frequent bolus injections of bupivacaine (15 mL 2.5 mg/mL) preperitoneally through catheters placed intraoperatively in women who had undergone hysterectomy.
Postoperative pain and analgesic requirements were studied in a double-blind randomized trial including 41 patients. During surgery, the patients were randomized to one of two groups, and the investigators were blinded. Prior to closure of the peritoneum, the surgeon placed a catheter between the muscle layer and the peritoneum on each side of the wound. One group (n = 22) received bupivacaine (15 mL 2.5 mg/mL) every 4 hours for 48 hours via each catheter starting in the operating room. The placebo group (n = 19) received saline in a like manner. Postoperative pain was evaluated using a visual analog scale (VAS) and verbal rating scale (VRS) twice a day for 2 days at rest and on movement. Requirements of supplementary analgesics were monitored, as was wound infection after discharge.
Bupivacaine administered preperitoneally did not improve analgesia at rest, during coughing, or during mobilization compared with saline. No difference between the groups was found regarding analgesic requirements. No complications of postoperative wound healing or toxic side effects were seen.
Bolus injections of bupivacaine through intraoperative placed catheters did not improve analgesia postoperatively compared with saline injections.
众所周知，局部麻醉剂伤口浸润可不同程度减轻术后疼痛，且副作用极少。先前一项研究表明，局部麻醉剂应用于筋膜下而非皮下层时镇痛效果更佳。本研究调查了在接受子宫切除术的女性患者术中通过放置的导管腹膜内频繁推注布比卡因（15毫升2.5毫克/毫升）的效果。
在一项纳入41例患者的双盲随机试验中研究术后疼痛和镇痛需求。手术期间，患者被随机分为两组之一，研究人员保持盲态。在关闭腹膜前，外科医生在伤口两侧的肌肉层和腹膜之间放置一根导管。一组（n = 22）从手术室开始，通过每根导管每4小时接受布比卡因（15毫升2.5毫克/毫升），持续48小时。安慰剂组（n = 19）以同样方式接受生理盐水。术后疼痛采用视觉模拟量表（VAS）和语言评定量表（VRS），在休息和活动时每天评估两次，持续2天。监测补充镇痛药的需求以及出院后的伤口感染情况。
与生理盐水相比，腹膜内给予布比卡因在休息、咳嗽或活动时并未改善镇痛效果。两组在镇痛需求方面未发现差异。未观察到术后伤口愈合并发症或毒性副作用。
与注射生理盐水相比，通过术中放置的导管推注布比卡因术后并未改善镇痛效果。
