Cnar Surhan Ozer, Kum Ulkü, Cevizci Nuri, Kayaoglu Semra, Oba Sibel
Department of Anesthesiology, Sisli Etfal Teaching and Research Hospital, Istanbul, Turkey.
Eur J Anaesthesiol. 2009 May;26(5):430-4. doi: 10.1097/EJA.0b013e32832974fc.
The present study compared the postoperative analgesic effects of preincisional and postincisional wound infiltration with levobupivacaine and postoperative cortisol and prolactin levels in children following inguinal hernia repair.
Ninety-six children aged 2-10 years who were undergoing elective inguinal hernia repair were randomly enrolled in this study. In group A (n = 32), 0.25 ml kg levobupivacaine (5 mg ml) was infiltrated after induction of general anaesthesia. In group B (n = 32), 0.25 ml kg levobupivacaine (5 mg ml) was infiltrated before the end of the surgery. Group C (n = 32) did not receive levobupivacaine infiltration at any time. Mean arterial pressure, heart rate, objective pain score, adverse effects and the number of rescue analgesics were recorded for 24 h. Blood samples were withdrawn following induction of anaesthesia and at 40 min after the end of surgery for measurement of blood cortisol and prolactin levels.
The rescue analgesic administration, objective pain scores, heart rate, postoperative plasma cortisol and prolactin levels were higher in group C than in either group A or group B (P < 0.05). There were no differences in these parameters between the two treatment groups (P > 0.05). Postoperative plasma cortisol and prolactin levels were significantly higher in all three groups than preoperative plasma cortisol and prolactin levels (P < 0.001).
Wound infiltration with levobupivacaine after induction of general anaesthesia and before the end of the surgery both provide postoperative pain relief following hernia repair, and decrease the stress response to postoperative pain.
本研究比较了左旋布比卡因切口前和切口后伤口浸润的术后镇痛效果以及小儿腹股沟疝修补术后的皮质醇和催乳素水平。
96例年龄在2至10岁接受择期腹股沟疝修补术的儿童被随机纳入本研究。A组（n = 32），在全身麻醉诱导后注入0.25 ml/kg左旋布比卡因（5 mg/ml）。B组（n = 32），在手术结束前注入0.25 ml/kg左旋布比卡因（5 mg/ml）。C组（n = 32）在任何时间均未接受左旋布比卡因浸润。记录24小时内的平均动脉压、心率、客观疼痛评分、不良反应及补救性镇痛药的使用次数。在麻醉诱导后及手术结束后40分钟采集血样，测定血皮质醇和催乳素水平。
C组的补救性镇痛药使用量、客观疼痛评分、心率、术后血浆皮质醇和催乳素水平均高于A组和B组（P < 0.05）。两个治疗组之间这些参数无差异（P > 0.05）。所有三组术后血浆皮质醇和催乳素水平均显著高于术前血浆皮质醇和催乳素水平（P < 0.001）。
全身麻醉诱导后及手术结束前用左旋布比卡因进行伤口浸润均可在疝修补术后提供术后疼痛缓解，并降低对术后疼痛的应激反应。
