Pfeiffer U, Dodson M E, Van Mourik G, Kirby J, McLoughlin G A
Department of Vascular Surgery, Royal Liverpool Hospital, England.
Ann Vasc Surg. 1991 Jan;5(1):80-4. doi: 10.1007/BF02021784.
In a double blind trial 72 patients having elective aortic surgery were randomized to receive either 40 ml of 0.25% bupivacaine or 40 ml of saline through one or two indwelling wound irrigation catheters every four hours over a total of 48 hours. In transverse incisions the two catheters were randomly placed either subcutaneously or in the rectus sheath; in vertical incisions one catheter was placed subcutaneously. Analgesia was assessed by visual analogue score on Postoperative Days 1 and 2 and the number of doses of intramuscular morphine given during the instillation period. Pulmonary function was monitored by forced expiratory volume and peak flow on Postoperative Days 1 to 5; arterial blood gases were monitored preoperatively and Postoperative Day 2. In all parameters evaluated there was no statistically significant difference between the saline (n = 33) or the bupivacaine (n = 37) groups. Site of the catheter in the transverse groups made no difference. Comparing vertical (n = 21) and transverse (n = 49) incisions, the mean visual analogue scores on the first postoperative day were 40 and 29, respectively (p less than 0.05). Wound instillation with bupivacaine neither improves pulmonary function nor reduces morphine requirements when compared to saline. Transverse incisions may be less painful than vertical ones.
在一项双盲试验中，72例择期行主动脉手术的患者被随机分组，通过一或两根留置的伤口冲洗导管，每4小时分别给予40毫升0.25%布比卡因或40毫升生理盐水，共持续48小时。对于横向切口，两根导管随机置于皮下或腹直肌鞘内；对于纵向切口，一根导管置于皮下。在术后第1天和第2天通过视觉模拟评分评估镇痛效果，并记录滴注期间肌内注射吗啡的剂量。在术后第1至5天通过用力呼气量和峰值流速监测肺功能；术前及术后第2天监测动脉血气。在所有评估参数中，生理盐水组（n = 33）和布比卡因组（n = 37）之间无统计学显著差异。横向切口组中导管位置无差异。比较纵向切口组（n = 21）和横向切口组（n = 49），术后第1天的平均视觉模拟评分别分为40和29（p < 0.05）。与生理盐水相比，布比卡因伤口滴注既不能改善肺功能，也不能减少吗啡用量。横向切口可能比纵向切口疼痛程度轻。
