Pappas-Gogos George, Tsimogiannis Konstandinos E, Zikos Nicolaos, Nikas Konstantinos, Manataki Adamantia, Tsimoyiannis Evangelos C
Department of Surgery, G. Hatzikosta General Hospital, Makriyanni Avenue, Ioannina, Greece.
Surg Endosc. 2008 Sep;22(9):2036-45. doi: 10.1007/s00464-008-9762-x. Epub 2008 Feb 13.
A clinical trial was designed to assess the use of preincisional and intraperitoneal ropivacaine, combined or not with normal saline, to reduce pain after laparoscopic cholecystectomy (LC).
For this trial, 120 patients were randomly assigned to six groups. For all the patients, preincisional local infiltration of ropivacaine around the trocar wounds was performed. Group A had infusion of ropivacaine at the beginning of the LC. Group B had infusion of ropivacaine at the beginning of the LC plus normal saline infusion at the end. Group C had normal saline infusion and ropivacaine at the end of the LC. Group D had infusion of ropivacaine at the beginning of the LC plus normal saline infusion at the end and a subhepatic closed drain. Group E had ropivacaine at the end of the LC. Group F (control group) had neither ropivacaine nor normal saline infusion. Shoulder tip and abdominal pain were registered at 2, 4, 6, 12, 24, 48, and 72 h postoperatively using a visual analog score (VAS).
Significantly lower pain scores were observed in group B than in group A at 2, 4, 6, 12, and 24 h or in groups C, D, E, and F at 2, 4, 6, 12, 24, and 48 h. Group A also had significantly lower pain scores than groups C, D, E, and F at 2, 4, 6, 12, 24, and 48 h. Requests for analgesics also were significantly less in group B than in group A at 2, 4, 6, 12, and 24 h or in groups C, D, and E at 2, 4, 6, 12, 24, and 48 h. Demand for additional analgesia was less in group B than in groups A, C, D, E, and F at 2, 4, 6, 12, and 24 h and in group A than in groups C, D, E, and F at 2, 4, 6, and 12 h.
Preincisional local infiltration plus intraperitoneal infusion of ropivacaine at the beginning of LC combined with normal saline infusion at the end of the procedure is a safe and valid method for reducing pain after LC.
设计一项临床试验以评估术前及腹腔内使用罗哌卡因（联合或不联合生理盐水）对减轻腹腔镜胆囊切除术（LC）后疼痛的效果。
在该试验中，120例患者被随机分为六组。所有患者均在套管针伤口周围进行术前罗哌卡因局部浸润。A组在LC开始时输注罗哌卡因。B组在LC开始时输注罗哌卡因并在结束时输注生理盐水。C组在LC结束时输注生理盐水和罗哌卡因。D组在LC开始时输注罗哌卡因并在结束时输注生理盐水且放置肝下封闭引流管。E组在LC结束时使用罗哌卡因。F组（对照组）既不使用罗哌卡因也不输注生理盐水。术后2、4、6、12、24、48和72小时使用视觉模拟评分（VAS）记录肩部和腹部疼痛情况。
在术后2、4、6、12和24小时，B组的疼痛评分显著低于A组；在术后2、4、6、12、24和48小时，B组的疼痛评分显著低于C、D、E和F组。在术后2、4、6、12、24和48小时，A组的疼痛评分也显著低于C、D、E和F组。在术后2、4、6、12和24小时，B组的镇痛药物需求也显著少于A组；在术后2、4、6、12、24和48小时，B组的额外镇痛需求少于A、C、D、E和F组；在术后2、4、6和12小时，A组的额外镇痛需求少于C、D、E和F组。
LC开始时进行术前局部浸润加腹腔内输注罗哌卡因并在手术结束时联合输注生理盐水是减轻LC后疼痛的一种安全有效的方法。
