Lau H, Patil N G, Lee F, Yuen W K
Department of Surgery, University of Hong Kong Medical Center, Tung Wah Hospital, 12 Po Yan Street, Sheung Wan, Hong Kong SAR.
Surg Endosc. 2002 Jan;16(1):159-62. doi: 10.1007/s00464-001-8106-x. Epub 2001 Oct 19.
The extraperitoneal instillation of bupivacaine has been shown to be superior to the use of a placebo for postoperative analgesia following endoscopic extraperitoneal inguinal hernioplasty. The objective of the present study was to compare the efficacy of postoperative analgesia by local wound infiltration to instillation of the extraperitoneal space with bupivacaine.
Between 1 September 1999 and 2 June 2000, a total of 100 patients who underwent unilateral endoscopic extraperitoneal inguinal hernioplasties were recruited to receive either local wound infiltration with 10 ml of 0.5% bupivacaine (group I, n = 50) or instillation of the extraperitoneal space with 40 ml of 0.25% bupivacaine after mesh placement (group II, n = 50). Daily postoperative pain was assessed by visual analogue pain score on a scale from 0 to 10 at rest and upon coughing. Total amount of oral analgesic consumed and clinical outcomes of the two groups were compared.
A comparison of daily pain scores of the two groups at rest and upon coughing showed no significant difference (p = ns). The mean number of oral analgesic tablets consumed were 3.2 +/- 0.5 (SEM) and 3.3 +/- 0.5 (SEM) in groups I and II, respectively (p = ns). During follow-up, asympatomatic groin collections were more common in group II (n = 4) than group I (n = 2) (p = ns).
Compared to local wound infiltration with bupivacaine, the extraperitoneal instillation of bupivacaine did not bestow any additional analgesic benefits. Therefore, the routine infiltration of skin incisions with bupivacaine is recommended after endoscopic extraperitoneal inguinal hernioplasty.
在腹腔镜腹膜外腹股沟疝修补术后，已证明布比卡因腹膜外滴注在术后镇痛方面优于使用安慰剂。本研究的目的是比较局部伤口浸润与布比卡因腹膜外间隙滴注的术后镇痛效果。
在1999年9月1日至2000年6月2日期间，共招募了100例行单侧腹腔镜腹膜外腹股沟疝修补术的患者，分别接受10 ml 0.5%布比卡因局部伤口浸润（I组，n = 50）或在放置补片后用40 ml 0.25%布比卡因腹膜外间隙滴注（II组，n = 50）。术后每天通过视觉模拟疼痛评分法评估静息和咳嗽时的疼痛程度，比较两组口服镇痛药的总消耗量及临床结果。
两组静息和咳嗽时每日疼痛评分比较无显著差异（p = 无统计学意义）。I组和II组口服镇痛片的平均数量分别为3.2±0.5（标准误）和3.3±0.5（标准误）（p = 无统计学意义）。随访期间，II组（n = 4）无症状性腹股沟积液比I组（n = 2）更常见（p = 无统计学意义）。
与布比卡因局部伤口浸润相比，布比卡因腹膜外滴注未带来额外的镇痛益处。因此，建议腹腔镜腹膜外腹股沟疝修补术后常规用布比卡因浸润皮肤切口。
