Wang Louis William, Wong Shing Wai, Crowe Philip John, Khor Kok Eng, Jastrzab Grazyna, Parasyn Andrew David, Walsh William Robert
Department of Surgery, Prince of Wales Hospital, New South Wales, Australia.
ANZ J Surg. 2010 Nov;80(11):794-801. doi: 10.1111/j.1445-2197.2010.05339.x.
The use of a continuous local anaesthesia infusion after laparotomy may reduce opioid requirements and facilitate earlier return of bowel function, independent mobilization and hospital discharge.
We performed a double-blinded, randomized controlled trial on 55 patients who underwent laparotomy. Patients were randomly allocated to receive a continuous infusion of either 0.2% ropivacaine or normal saline into their midline abdominal wound at the fascial level. The end points of the study were: total opioid requirements at 24 and 48 h; time to first flatus, bowel movement and independent ambulation; length of hospital stay; complications; and daily mean patient-reported pain scores at rest and movement.
The two treatment groups were well controlled for factors that influence analgesia requirements, including age, weight, length of wound incision and type of operation. Patients allocated to ropivacaine infusion used, on average, 32 mg less morphine at 48 h (95% confidence interval 7, 57; P= 0.01). This was highly statistically significant after adjusting for age, gender and type of operation (P= 0.0006). Ropivacaine infusion was associated with a significantly decreased time to independent mobilization (P= 0.02), time to first flatus (P= 0.02) and reduced post-operative ileus (2/28 versus 9/27, χ(2) = 5.89, P= 0.02). There was no significant effect of ropivacaine infusion on time to first bowel movement (P= 0.94) nor length of hospital stay (P= 0.77).
Local anaesthesia infusion at the fascial plane provides effective analgesia. This improves patient recovery through earlier return to bowel function and mobilization.
剖腹手术后持续局部麻醉输注可减少阿片类药物用量，并促进肠功能更早恢复、实现独立活动及出院。
我们对55例行剖腹手术的患者进行了一项双盲随机对照试验。患者被随机分配接受在筋膜层将0.2%罗哌卡因或生理盐水持续输注至腹部中线切口。研究终点包括：24小时和48小时的阿片类药物总用量；首次排气、排便及独立行走的时间；住院时间；并发症；以及患者报告的静息和活动时每日平均疼痛评分。
两个治疗组在影响镇痛需求的因素方面得到了良好控制，这些因素包括年龄、体重、伤口切口长度和手术类型。接受罗哌卡因输注的患者在48小时时平均使用的吗啡量少32毫克（95%置信区间7，57；P = 0.01）。在对年龄、性别和手术类型进行调整后，这具有高度统计学意义（P = 0.0006）。罗哌卡因输注与独立活动时间显著缩短（P = 0.02）、首次排气时间显著缩短（P = 0.02）以及术后肠梗阻减少相关（2/28对9/27，χ(2)=5.89，P = 0.02）。罗哌卡因输注对首次排便时间（P = 0.94）和住院时间（P = 0.77）没有显著影响。
筋膜平面局部麻醉输注可提供有效的镇痛。这通过更早恢复肠功能和活动来改善患者恢复情况。
