Lee I O, Kim S H, Kong M H, Lee M K, Kim N S, Choi Y S, Lim S H
Department of Anesthesia, College of Medicine, Korea University Guro Hospital, Seoul.
Can J Anaesth. 2001 Jun;48(6):545-50. doi: 10.1007/BF03016830.
To examine the combined preemptive effects of somatovisceral blockade during laparoscopic cholecystectomy (LC).
One hundred fifty-seven patients under general anesthesia receiving local infiltration and/or topical peritoneal local anesthesia were studied. Patients were randomized to receive a total of 150 mg (0.25% 60 mL) bupivacaine via periportal (20 mL) and intraperitoneal (40 mL with 1:200,000 epinephrine) administration of each. Group A received preoperative periportal bupivacaine before incision and intraperitoneal bupivacaine immediately after the pneumoperitoneum. Group B received periportal and intraperitoneal bupivacaine at the end of the operation. Group C (preoperative) and Group D (postoperative) received only periportal bupivacaine and Group E (preoperative) and Group F (post-operative) received only intraperitoneal bupivacaine. The control group received no treatment. Pain and nausea were recorded at one, two, three, six, nine, 12, 24, 36, and 48 hr postoperatively.
Throughout the postoperative 48 hr, incisional somatic pain dominated over other pain localizations in the control group (P <0.05). The incisional pain of groups A, B, C and D was significantly lower than that of the control group in the first and second hours. The incisional pain of groups A and C was significantly lower than that of the control group in the first three hours.
Incisional pain dominated during the first two post-operative days after LC. Preoperative somato-visceral or somatic local anesthesia reduced incisional pain during the first three post-operative hours. A combination of somato-visceral local anesthetic treatment did not reduce intraabdominal pain, shoulder pain or nausea more than somatic treatment alone. Preoperative incisional infiltration of local anesthetics is recommended.
探讨腹腔镜胆囊切除术（LC）期间躯体 - 内脏联合预先镇痛的效果。
对157例接受全身麻醉并接受局部浸润和/或局部腹膜局部麻醉的患者进行研究。患者被随机分为通过门静脉周围（20 mL）和腹腔内（40 mL加1:200,000肾上腺素）各给予总共150 mg（0.25% 60 mL）布比卡因。A组在切口前接受术前门静脉周围布比卡因，气腹后立即接受腹腔内布比卡因。B组在手术结束时接受门静脉周围和腹腔内布比卡因。C组（术前）和D组（术后）仅接受门静脉周围布比卡因，E组（术前）和F组（术后）仅接受腹腔内布比卡因。对照组不接受治疗。术后1、2、3、6、9、12、24、36和48小时记录疼痛和恶心情况。
在术后48小时内，对照组切口处的躯体疼痛比其他疼痛部位更为明显（P <0.05）。A、B、C和D组在术后第1和第2小时的切口疼痛明显低于对照组。A组和C组在术后前3小时的切口疼痛明显低于对照组。
LC术后前两天切口疼痛最为明显。术前躯体 - 内脏或躯体局部麻醉可减轻术后前3小时的切口疼痛。躯体 - 内脏联合局部麻醉治疗并不比单纯躯体治疗更能减轻腹内疼痛、肩部疼痛或恶心。建议术前对切口进行局部麻醉药浸润。
