Rakai Health Sciences Program, Entebbe, Uganda.
BJU Int. 2012 Apr;109(7):1068-71. doi: 10.1111/j.1464-410X.2011.10505.x. Epub 2011 Aug 30.
To assess self-reported pain control during and after surgery with a mixture of lignocaine and bupivacaine compared with lignocaine alone among male circumcision (MC) service recipients in Rakai, Uganda.
The two formulations of local anaesthesia for MC were used alternatively at weekly intervals in 360 patients; 179 received lignocaine alone and 181 received the lignocaine and bupivacaine mixture (LBmix). The proportions of men reporting pain during or after surgery, and the need for additional anaesthesia during surgery were determined for the LBmix vs lignocaine using Poisson adjusted rate ratios (RRs). Characteristics including age, weight, surgeon (medical officer vs clinical officer), surgical method and duration of surgery were compared between the arms using two-sample t-tests and chi-square tests.
Patient and provider characteristics were comparable between the two anaesthetic groups. A higher proportion of patients reported pain during surgery in the lignocaine group (adjusted RR 11.6, 95% confidence interval [CI] 3.5-37.9, P < 0.001), required additional anaesthesia (adjusted RR 4.8, 95% CI 1.4-17.1, P = 0.015), and were more likely to report pain during the immediate postoperative period (adjusted RR 3.4, 95% CI 2.3-5.0, P < 0.001). These differences were particularly marked among patients with MC times longer than the median (adjusted RR 13.4, 95% CI 3.1-57.0, P < 0.001).
The LBmix significantly reduced pain associated with MC and the need for additional anaesthesia during MC.
评估在乌干达 Rakai 地区接受男性割礼（MC）服务的男性中，与单独使用利多卡因相比，使用利多卡因和布比卡因混合物（LBmix）在手术中和手术后自我报告的疼痛控制情况。
360 名患者每周交替使用两种局部麻醉剂进行 MC；其中 179 名接受单独的利多卡因，181 名接受利多卡因和布比卡因混合物（LBmix）。使用泊松调整后的率比（RR）比较 LBmix 与利多卡因在手术中或手术后报告疼痛的男性比例以及手术中需要额外麻醉的比例。使用两样本 t 检验和卡方检验比较两组之间的患者和提供者特征，包括年龄、体重、手术医生（医师与临床医生）、手术方法和手术持续时间。
两组麻醉剂的患者和提供者特征相似。利多卡因组在手术中报告疼痛的患者比例更高（调整后的 RR 为 11.6，95%置信区间 [CI] 为 3.5-37.9，P<0.001），需要额外的麻醉（调整后的 RR 为 4.8，95% CI 为 1.4-17.1，P=0.015），并且在术后即刻期间更有可能报告疼痛（调整后的 RR 为 3.4，95% CI 为 2.3-5.0，P<0.001）。在 MC 时间长于中位数的患者中，这些差异尤为明显（调整后的 RR 为 13.4，95% CI 为 3.1-57.0，P<0.001）。
LBmix 显著减轻了 MC 相关疼痛，并减少了 MC 期间额外麻醉的需求。
