Golubović Snjezana, Golubović Vesna, Cindrić-Stancin Marija, Tokmadzić Vlatka Sotosek
Clinic of Anesthesiology and Intensive Care, University Hospital Center "Rijeka", Rijeka, Croatia.
Coll Antropol. 2009 Mar;33(1):299-302.
The type of pain after laparoscopic surgery differs considerably from that seen after laparotomy. Whereas laparotomy results mostly in parietal pain, patients after laparoscopic cholecystectomy complain more of visceral pain results from the stretching of intraabdominal cavity, peritoneal inflammation and phrenic nerve irritation caused by residual carbon dioxide in the peritoneal cavity. Intraperitoneal (IP) administration of some drugs can be effective for pain relief after laparoscopic surgery. The purpose of this study was to asses the effects of intraperitoneal application of bupivacaine or bupivacaine in combination with tramadol on pain relief after laparoscopic cholecystectomy. After informed written consent and local ethic committee approval, ninthy patients of ASA I and II grade undergoing elective laparoscopic cholecystectomy for cholelythiasis were recruited in the study. At the end of laparoscopic cholecystectomy 30 patients in each group received 50 mL saline 0.9% (group C), bupivacaine 0.25% (group B) or bupivacaine 0.25% with tramadol 100 mg (group T). VAS pain was estimated at 30 minutes, 1, 2, 4 and 24 hours after surgery. Postoperative analgesic requires were also assessed. Pain scores were significantly lower in group receiving the IP bupivacaine with tramadol and bupivacaine compared to saline group. Intraperitoneal applications of these drugs reduced consumption of supplementary postoperative analgesic medication. Intraperitoneal administration of bupivacaine with tramadol and bupivacaine are simple to use and effective in a reduction ofpain after laparoscopic cholecystectomy. In our study we found no differences between bupivacaine with tramadol and bupivacaine in postoperative VAS score and analgesic requirements.
腹腔镜手术后的疼痛类型与开腹手术后的疼痛有很大不同。开腹手术主要导致壁层疼痛，而腹腔镜胆囊切除术后的患者更多抱怨的是内脏疼痛，这是由腹腔内拉伸、腹膜炎症以及腹腔内残留二氧化碳刺激膈神经引起的。腹腔内（IP）给予某些药物对腹腔镜手术后的疼痛缓解可能有效。本研究的目的是评估腹腔内应用布比卡因或布比卡因联合曲马多对腹腔镜胆囊切除术后疼痛缓解的效果。在获得知情书面同意并经当地伦理委员会批准后，本研究招募了90例因胆结石接受择期腹腔镜胆囊切除术的ASA I和II级患者。在腹腔镜胆囊切除术结束时，每组30例患者分别接受50 mL 0.9%生理盐水（C组）、0.25%布比卡因（B组）或0.25%布比卡因加100 mg曲马多（T组）。在术后30分钟、1、2、4和24小时评估视觉模拟评分（VAS）疼痛情况。还评估了术后镇痛需求。与生理盐水组相比，接受腹腔内布比卡因联合曲马多和布比卡因的组疼痛评分显著更低。这些药物的腹腔内应用减少了术后补充镇痛药物的消耗。腹腔内给予布比卡因联合曲马多和布比卡因使用简单，对减轻腹腔镜胆囊切除术后的疼痛有效。在我们的研究中，我们发现布比卡因联合曲马多和布比卡因在术后VAS评分和镇痛需求方面没有差异。
