Shams Mohamed E, Atef Hosam M
Department of Surgery, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
Saudi J Anaesth. 2010 Sep;4(3):127-30. doi: 10.4103/1658-354X.71134.
Postoperative pain control has been studied extensively, including many perioperative pain control procedures. Unfortunately, the impact of the surgical technique was not objectively studied.
The aim of this study is to evaluate if the type of surgical dissection needed for extensive abdominal wall dissection actually has an effect in the reduction of postoperative pain or not.
Forty adult patients, 19 males and 21 females, were randomly divided into two groups with each group containing 20 patients having different varieties of anterior abdominal wall ventral hernia. Patients in group I had their hernias and abdominal wall flaps dissected by only sharp dissection using scalpel. Patients in group II had their hernias and abdominal wall flaps dissected using mainly blunt dissection assisted by sharp dissection where blunt dissection could not do the job. All the patients had general anesthesia. No preemptive analgesia was used. Nalbufen was used as the only postoperative pain killer and the total amount used of it was treated as the indicator for the intensity of postoperative pain.
The results of the present study showed that the total amount of Nalbufen used for the control of postoperative pain is significantly less in group I throughout the postoperative follow-up period.
This study concludes that use of sharp dissection in cases of extensive abdominal wall dissection is statistically better than other methods of dissection in terms of postoperative pain control.
术后疼痛控制已得到广泛研究,包括许多围手术期疼痛控制程序。不幸的是,手术技术的影响尚未得到客观研究。
本研究的目的是评估广泛腹壁剥离所需的手术剥离类型是否真的对减轻术后疼痛有影响。
40例成年患者,19例男性和21例女性,随机分为两组,每组20例,患有不同类型的前腹壁腹疝。第一组患者仅使用手术刀进行锐性剥离来分离疝和腹壁皮瓣。第二组患者主要采用钝性剥离,并在钝性剥离无法完成时辅以锐性剥离来分离疝和腹壁皮瓣。所有患者均采用全身麻醉。未使用超前镇痛。纳布啡用作唯一的术后止痛药,其总用量作为术后疼痛强度的指标。
本研究结果表明,在术后整个随访期间,第一组用于控制术后疼痛的纳布啡总量显著较少。
本研究得出结论,在广泛腹壁剥离的情况下,就术后疼痛控制而言,使用锐性剥离在统计学上优于其他剥离方法。