Cheong W K, Seow-Choen F, Eu K W, Tang C L, Heah S M
Department of Colorectal Surgery, Singapore General Hospital, 1 Hospital Drive, Singapore 169608.
Br J Surg. 2001 Mar;88(3):357-9. doi: 10.1046/j.1365-2168.2001.01717.x.
Opioids are often used to decrease pain following laparotomy but are associated with unwanted side-effects. The effectiveness of local perfusion of bupivacaine 0.5 per cent following laparotomy was studied.
A prospective randomized study involving patients undergoing laparotomy for major colorectal surgery using a left iliac fossa skin crease incision was undertaken. Patients were randomized to receive either intermittent intravenous morphine infusion on demand with patient-controlled analgesia (PCA group) or continuous wound perfusion of local bupivacaine 0.5 per cent for 60 h (LA group).
Seventy patients were recruited, 35 in each group. Patient demographics, surgical and recovery variables and complications were comparable in the two groups. The wound lengths were similar (median 14 cm in both groups). There was no statistically significant difference in postoperative pain scores at rest and with movement between the two groups, except for pain scores at rest on the first postoperative day (P = 0.03). The median total amount of morphine used was significantly greater in the PCA group (median 38 versus 0 mg in the LA group; P < 0.001).
Direct continuous local wound perfusion of bupivacaine 0.5 per cent is as effective as PCA for postoperative pain relief after laparotomy. It is a safe and feasible alternative to parenteral opioids.
阿片类药物常用于减轻剖腹手术后的疼痛，但会产生不良副作用。本研究探讨了剖腹手术后局部灌注0.5%布比卡因的有效性。
采用前瞻性随机研究，纳入因大肠手术行剖腹手术并采用左髂窝皮肤皱襞切口的患者。患者随机分为两组，一组按需接受间断静脉注射吗啡并采用患者自控镇痛（PCA组），另一组接受持续60小时的0.5%布比卡因局部伤口灌注（LA组）。
共招募70例患者，每组35例。两组患者的人口统计学特征、手术及恢复变量和并发症具有可比性。伤口长度相似（两组中位数均为14 cm）。两组术后静息和活动时的疼痛评分无统计学显著差异，但术后第1天静息时的疼痛评分除外（P = 0.03）。PCA组吗啡总用量中位数显著高于LA组（中位数分别为38 mg和0 mg；P < 0.001）。
直接持续局部伤口灌注0.5%布比卡因在减轻剖腹手术后疼痛方面与PCA同样有效。它是胃肠外阿片类药物的一种安全可行的替代方法。
