Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India.
J Minim Invasive Gynecol. 2011 Jan-Feb;18(1):43-7. doi: 10.1016/j.jmig.2010.08.695. Epub 2010 Nov 19.
To compare the analgesic efficacy of lignocaine gel-soaked Silastic bands compared with rectal diclofenac suppositories in patients undergoing interval laparoscopic sterilization under conscious sedation.
Prospective, randomized, controlled, single-blinded, clinical trial.
Day-case center in a tertiary care hospital in India.
Ninety-six women undergoing interval laparoscopic sterilization using Silastic bands (Yoon rings) randomly allocated by computer-generated random numbers into 3 groups.
All women received intravenous sedation with injection diazepam and pentazocine along with local infiltration lignocaine injected at the site of the incision meant for insertion of the single site laparocator. In group 1 (n = 32), the Silastic bands (Falope rings) were presoaked in 2% sterile lignocaine gel; in group 2 (n = 32), women received a 100-mg rectal diclofenac suppository while on the operating table; and women in group 3 received only conventional analgesic. Pain perception was assessed using an 11-point visual analog score just after the procedure while still on the table (zero minutes), at 30 minutes and 1 hour after the procedure, and at discharge.
The women in all 3 groups were comparable insofar as age and parity. At zero minutes (while on the operating table), the pain score in all 3 groups was similar. However, the pain scores at 30 and 60 minutes, and at discharge were significantly lower in groups 1 and group 2 compared with group 3. However, 2 women (6.25%) in group 2 and 6 (18.75%) in group 3 required supplemental analgesia within 1 hour, and were administered a 500-mg oral dose of mefenamic acid. The need for further analgesia was significantly lower in groups 1 and 2 compared with group 3 (p = .02). Comparison of groups 1 and 3 revealed that in group 1, the pain scores were significantly lower at 30 minutes (p = .02), 1 hour (p = .005), and at discharge (p = .004). No patients in group 1 requested analgesia, whereas 6 women in group 3 asked for further analgesia within an hour postoperatively (p = .01). Similarly in groups 2 and 3, women who received diclofenac suppositories had significantly lower pain scores at the specified intervals (p = 0.02, 0.002, and 0.02, respectively).
Application of lignocaine gel to Falope rings and preoperative insertion of a rectal diclofenac suppository are simple and effective measures for pain control in the early postoperative period in patients undergoing day-case laparoscopic sterilization under conscious sedation. Either method could be incorporated into routine practice, depending on patient and physician choice.
比较利多卡因凝胶浸泡的 Silastic 带与直肠双氯芬酸钠栓剂在清醒镇静下间隔腹腔镜绝育术患者中的镇痛效果。
前瞻性、随机、对照、单盲、临床试验。
印度一家三级保健医院的日间手术中心。
96 名接受 Silastic 带（Yoon 环）间隔腹腔镜绝育术的女性，通过计算机生成的随机数随机分配至 3 组。
所有女性均接受静脉注射地西泮和戊乙奎醚镇静，并在单部位腹腔镜穿刺器插入部位局部注射利多卡因浸润。在第 1 组（n = 32）中，Silastic 带（Falope 环）在 2%无菌利多卡因凝胶中浸泡；在第 2 组（n = 32）中，女性在手术台上接受 100mg 直肠双氯芬酸钠栓剂；第 3 组仅接受常规镇痛。术后仍在手术台上时（零分钟）、术后 30 分钟和 1 小时以及出院时，使用 11 点视觉模拟评分评估疼痛感知。
3 组女性在年龄和产次方面均具有可比性。在零分钟（仍在手术台上）时，3 组的疼痛评分相似。然而，第 1 组和第 2 组在 30 分钟和 60 分钟以及出院时的疼痛评分明显低于第 3 组。然而，第 2 组有 2 名女性（6.25%）和第 3 组有 6 名女性（18.75%）在 1 小时内需要补充镇痛，并给予 500mg 口服甲芬那酸。与第 3 组相比，第 1 组和第 2 组需要进一步镇痛的人数明显减少（p =.02）。第 1 组和第 3 组的比较显示，第 1 组在 30 分钟（p =.02）、1 小时（p =.005）和出院时（p =.004）的疼痛评分明显较低。第 1 组没有患者要求镇痛，而第 3 组有 6 名女性在术后 1 小时内要求进一步镇痛（p =.01）。同样，在第 2 组和第 3 组中，接受双氯芬酸钠栓剂的女性在指定时间间隔的疼痛评分明显较低（p = 0.02、0.002 和 0.02）。
在清醒镇静下日间腹腔镜绝育术患者中，将利多卡因凝胶应用于 Falope 环和术前插入直肠双氯芬酸钠栓剂是控制术后早期疼痛的简单有效措施。两种方法均可根据患者和医生的选择纳入常规实践。
