Bays R A, Barry L, Vasilenko P
Department of Surgery, Saginaw Cooperative Hospitals Inc., Michigan.
Surg Gynecol Obstet. 1991 Dec;173(6):433-7.
The intraoperative use of local anesthetic agents to decrease postoperative pain has been used in many types of procedures. Most of these techniques involve needle injection of anesthetic and result in a low but troublesome incidence of complications. In this study, we evaluated the reliability, safety, and efficacy of a technique emphasizing bathing of tissues with anesthetic rather than needle injection for relieving postoperative pain. Thirty consecutive patients undergoing outpatient elective inguinal herniorrhaphy with general anesthetic were prospectively randomized into four treatment groups. Group 1 received 0.5 per cent bupivacaine plus epinephrine 1 to 200,000; group 2, 0.5 per cent bupivacaine; group 3, normal saline solution, and group 4, no treatment. At the end of the repair, one-third of the test solution (approximately 5 milliliters) was bathed along the spermatic cord throughout its length in the inguinal canal. The external oblique aponeurosis was closed superficial to the cord structures and another one-third of the solution was instilled into the wound. Just prior to the end of skin closure the remaining solution was instilled subcutaneously. No needles were used to instill the solutions and they were not suctioned or removed from the wound. Data collection consisted of an analog type of patient questionnaire allowing subjective assessment of postoperative pain at various time intervals during the first 20 hours postoperatively. Pain medication provided was propoxyphene, 100 milligrams and acetaminophen, 650 milligrams every three hours as needed. Total doses of pain medication for the study period and the time to first pain medication requirement were obtained. Results were analyzed using analysis of variance, and Wilcoxon ranked sums test. Patients in group 1 (0.5 per cent bupivacaine with epinephrine) exhibited significantly less pain than those in groups 3 (saline solution) and 4 (control) for more than 12 hours postoperatively. Patients in group 2 (0.5 per cent bupivacaine) likewise experienced less pain than those in groups 3 and 4 through seven hours. The patients receiving saline solution were not significantly different than those in the control group throughout. Objectively, groups 1 and 2 required fewer total doses of pain medication and waited longer before requesting oral pain medication postoperatively compared with those in the control group. No complications occurred that could be attributed to the technique. The results of this study indicate that the bathing of wounds with 0.5 per cent bupivacaine with or without epinephrine 1:200,000 is a safe and effective method of decreasing postoperative pain for several hours in patients undergoing elective inguinal herniorrhaphy.(ABSTRACT TRUNCATED AT 400 WORDS)
术中使用局部麻醉剂以减轻术后疼痛已应用于多种手术。这些技术大多涉及用针注射麻醉剂，并发症发生率虽低但令人困扰。在本研究中，我们评估了一种强调用麻醉剂浸润组织而非针注射来减轻术后疼痛的技术的可靠性、安全性和有效性。连续30例接受全身麻醉的门诊择期腹股沟疝修补术患者被前瞻性随机分为四个治疗组。第1组接受0.5%布比卡因加1:200,000肾上腺素；第2组接受0.5%布比卡因；第3组接受生理盐水；第4组不治疗。修补结束时，将三分之一的测试溶液（约5毫升）沿精索全长在腹股沟管内浸润。腹外斜肌腱膜在精索结构浅面关闭，再将三分之一的溶液注入伤口。在皮肤缝合即将结束前，将剩余溶液皮下注入。溶液注入未使用针头，也未从伤口抽吸或清除。数据收集包括一份类似模拟量表的患者问卷，用于主观评估术后20小时内不同时间间隔的术后疼痛。按需每三小时提供的止痛药物为丙氧芬100毫克和对乙酰氨基酚650毫克。获得研究期间止痛药物的总剂量以及首次需要止痛药物的时间。结果采用方差分析和威尔科克森秩和检验进行分析。第1组（0.5%布比卡因加肾上腺素）患者术后12小时以上的疼痛明显轻于第3组（生理盐水）和第4组（对照组）。第2组（0.5%布比卡因）患者在7小时内的疼痛同样轻于第3组和第4组。接受生理盐水的患者与对照组在整个过程中无显著差异。客观上，与对照组相比，第1组和第2组术后所需止痛药物的总剂量更少，且在要求口服止痛药物前等待时间更长。未发生可归因于该技术的并发症。本研究结果表明，用0.5%布比卡因加或不加1:200,000肾上腺素浸润伤口是一种在择期腹股沟疝修补术患者中安全有效的减轻术后数小时疼痛的方法。（摘要截短至400字） )
