Di Pace Maria Rita, Cimador Marcello, Catalano Pieralba, Caruso Anna, Sergio Maria, Casuccio Alessandra, De Grazia Enrico
Pediatric Surgical Unit, Department of Mother and Child Care, Università di Palermo, Palermo, Italy.
J Laparoendosc Adv Surg Tech A. 2009 Dec;19(6):821-5. doi: 10.1089/lap.2008.0227.
Postoperative pain is less intense after laparoscopic than after open surgery. However, minimally invasive surgery is not a a pain-free procedure. Many trials have been done in adults using intraperitoneal and/or incisional local anesthetic, but similar studies have not yet been reported in the literature in children.
The aim of this study was to evaluate the analgesic effect of periportal infiltration and intraperitoneal instillation of ropivacaine in children undergoing laparoscopic surgery.
Thirty patients who underwent laparoscopic surgery were randomly allocated to one of three groups. Group A (n = 10) received local infiltration of port sites with 10 mL of ropivacaine. Group B (n = 10) received both an infiltration of port sites with 10 mL of ropivacaine and an intraperitoneal instillation of 10 mL of ropivacaine. Group C did not receive any analgesic treatment. The local anesthetic was always administered at the end of surgery. The degree of postoperative abdominal parietal pain, abdominal visceral pain, and shoulder pain was assessed by using a Wong-Baker pain scale and a Visual Analog Scale (VAS) at 3, 6 12, and 24 hours postoperatively. The following parameters were also evaluated: rescue analgesic treatment, length of hospital stay, and time of return to normal activities.
Three hours after operation, patients had low pain scores. Six and 12 hours postoperatively, the abdominal parietal pain was significantly higher (P < 0.0005) in group C than in the other two groups, both treated with an infiltration at the trocar sites; mean intensity of abdominal visceral pain was significantly lower (P < 0.0005) in group B than in groups A and C; the overall incidence of shoulder pain was significantly lower (P < 0.0005) in group B patients than in patients of groups A and C. At 20 hours postoperatively, pain scores were significantly reduced of intensity in all groups. Rescue analgesic treatment was significantly higher in group C, if compared to groups A and B 12 hours after the operation. No statistically significant difference was found in length of hospital stay, but children who received analgesic treatment had a more rapid return to normal activities than untreated patients (P < 0.0005).
Our study demonstrates that the combination of local infiltration and intraperitoneal instillation of ropivacaine is more effective for pain relief in children after laparoscopic surgery than the administration of ropivacaine only at the trocar sites.
腹腔镜手术后的疼痛强度低于开放手术后的疼痛强度。然而，微创手术并非无痛手术。针对成人使用腹腔内和/或切口局部麻醉剂已开展了许多试验，但儿童方面的类似研究在文献中尚未见报道。
本研究旨在评估罗哌卡因门静脉周围浸润和腹腔内注入对接受腹腔镜手术儿童的镇痛效果。
30例行腹腔镜手术的患者被随机分为三组。A组（n = 10）接受10 mL罗哌卡因对端口部位的局部浸润。B组（n = 10）接受10 mL罗哌卡因对端口部位的浸润以及10 mL罗哌卡因的腹腔内注入。C组未接受任何镇痛治疗。局部麻醉剂均在手术结束时给药。术后3、6、12和24小时，使用面部表情疼痛评分法和视觉模拟评分法（VAS）评估术后腹壁疼痛、腹腔内脏疼痛和肩部疼痛的程度。还评估了以下参数：补救性镇痛治疗、住院时间和恢复正常活动的时间。
术后3小时，患者疼痛评分较低。术后6小时和12小时，C组的腹壁疼痛明显高于其他两组，这两组均在套管针部位进行了浸润；B组腹腔内脏疼痛的平均强度明显低于A组和C组；B组患者肩部疼痛的总体发生率明显低于A组和C组患者。术后20小时，所有组的疼痛评分强度均显著降低。与A组和B组相比，术后12小时C组的补救性镇痛治疗明显更多。住院时间未发现统计学上的显著差异，但接受镇痛治疗的儿童比未治疗的患者恢复正常活动更快（P < 0.0005）。
我们的研究表明，罗哌卡因局部浸润与腹腔内注入相结合，在腹腔镜手术后儿童疼痛缓解方面比仅在套管针部位使用罗哌卡因更有效。
