Department of Surgery, Faculty of Medicine and HealthSciences, University of Auckland, Auckland, New Zealand.
J Hepatobiliary Pancreat Sci. 2010 Sep;17(5):637-56. doi: 10.1007/s00534-010-0271-7.
BACKGROUND/PURPOSE: With the advent of minimally invasive gallbladder surgery, and now with natural orifice techniques emerging, visceral nociception has been neglected as a cause of postoperative pain. A systematic review and metaanalysis was carried out to investigate the use of intraperitoneal local anesthetic (IPLA) in order to assess its role in laparoscopic cholecystectomy (LC). The aim of this systematic review was to appraise the clinical effects of this modality.
Comprehensive searches were conducted independently without language restriction. Studies were identified from the following databases from inception to September 2009: Cochrane Central Register of Controlled Trials (CENTRAL/CCTR), Cochrane Library, Medline, PubMed, Excerpta Medica Database (EMBASE), and Cumulative Index to Nursing and Allied Health Literature (CINHAL). Relevant meeting abstracts and reference lists were manually searched. Data analysis was performed using Review Manager Version 5.0 software.
Thirty randomized controlled trials were identified for review. The clinical heterogeneity of IPLA use was high. However, there appeared to be reduced pain, opioid use, and need for rescue analgesia, and reduced postoperative cortisol and glucose responses.
There is evidence in favor of IPLA in LC. Further trials of this modality in LC are not needed as these are unlikely to reduce clinical heterogeneity. IPLA should be trialled as future minimally invasive surgical techniques approach.
背景/目的：随着微创胆囊手术的出现，以及现在自然腔道技术的出现，内脏疼痛已被忽视为术后疼痛的原因。进行了系统评价和荟萃分析，以调查腹腔内局部麻醉（IPLA）的使用，以评估其在腹腔镜胆囊切除术（LC）中的作用。本系统评价的目的是评估这种方式的临床效果。
全面搜索，独立进行，无语言限制。从以下数据库中检索从开始到 2009 年 9 月的研究：Cochrane 对照试验中心注册库（CENTRAL/CCTR）、Cochrane 图书馆、Medline、PubMed、医学文摘数据库（EMBASE）和护理及相关健康文献累积索引（CINHAL）。手动搜索相关会议摘要和参考文献。数据分析使用 Review Manager Version 5.0 软件进行。
确定了 30 项随机对照试验进行综述。IPLA 使用的临床异质性很高。然而，似乎减少了疼痛、阿片类药物的使用和需要急救镇痛，以及减少了术后皮质醇和葡萄糖的反应。
有证据支持 LC 中使用 IPLA。不需要进一步的这种方式在 LC 中的试验，因为这些试验不太可能减少临床异质性。当未来的微创外科技术接近时，应试用 IPLA。
