Anesthesiology Department, Hospital Garcia de Orta, Lisboa, Portugal.
Anesth Analg. 2012 Jan;114(1):179-85. doi: 10.1213/ANE.0b013e3182368e87. Epub 2011 Oct 24.
The infusion of local anesthetic in the surgical wound is helpful in the multimodal management of postoperative pain. We hypothesized that local anesthetic wound infusion after cesarean delivery would provide better pain control than epidural morphine analgesia.
Healthy, term women scheduled for elective cesarean delivery were included in this assessor-blinded, randomized study. Patients were randomly assigned to receive analgesia through a multiorifice wound catheter placed below the fascia and connected to a 5 mL/h ropivacaine 2 mg/mL infusion or an epidural bolus of morphine 2 mg every 12 hours. Both analgesic regimens were continued for 48 hours. The primary outcome was pain at rest at 24 hours postoperatively using the verbal rating score for pain (0-10 scale). Pain intensity, rescue analgesia consumption, and side effects were assessed at 2, 6, 24, and 48 hours after cesarean delivery by an observer blinded to group allocation. Three months after discharge, patient satisfaction, residual pain, and surgical wound complications were assessed.
Fifty-eight women participated in the study. At 24 hours, the median rest verbal rating score for pain was 0 (interquartile range: 0-0) in the continuous infusion group and 3 in the epidural morphine group (interquartile range: 2-3; 95% confidence interval of difference: 1-3 units; P < 0.001). The median scores of the 2-, 6-, and 48-hour pain assessments at rest were also lower in the continuous wound infusion group than in the epidural morphine group, and at 2, 6, and 24 hours with movement (P < 0.001). The incidence of nausea, vomiting, pruritus, and urinary retention was significantly lower in the wound infusion group and time to recovery of bowel function was shorter. During the 48-hour follow-up evaluation, the median number of nurse visits attributed exclusively to the analgesic regimen was 1 (interquartile range: 1-2) in the continuous wound infusion group and 8 (interquartile range: 7-10) in the epidural morphine group (95% confidence interval of difference: 6-8 visits; P < 0.001).
Continuous wound infusion with ropivacaine for 48 hours after cesarean delivery was associated with better analgesia, a lower incidence of side effects, less need for nursing care, and shorter duration of stay compared with epidural morphine analgesia.
在手术伤口中输注局部麻醉剂有助于多模式管理术后疼痛。我们假设剖宫产术后局部麻醉剂伤口输注将比硬膜外吗啡镇痛提供更好的疼痛控制。
本研究为评估者设盲、随机研究，纳入择期行剖宫产的健康足月产妇。患者被随机分配接受通过置于筋膜下方的多孔伤口导管给予镇痛，连接至 5 mL/h 罗哌卡因 2mg/mL 输注或每 12 小时硬膜外推注吗啡 2mg。两种镇痛方案均持续 48 小时。主要结局为术后 24 小时静息时疼痛的视觉模拟评分（0-10 分）。在剖宫产术后 2、6、24 和 48 小时，由对分组情况设盲的观察者评估疼痛强度、解救镇痛药物消耗和副作用。出院后 3 个月评估患者满意度、残留疼痛和手术伤口并发症。
58 名女性参与了本研究。在 24 小时时，连续输注组静息时疼痛的中位数视觉模拟评分（0-10 分）为 0（四分位距：0-0），硬膜外吗啡组为 3（四分位距：2-3；95%置信区间差值：1-3 单位；P<0.001）。连续伤口输注组在 2、6 和 48 小时的静息时疼痛评估中位数评分也低于硬膜外吗啡组，在运动时也更低（P<0.001）。恶心、呕吐、瘙痒和尿潴留的发生率在伤口输注组明显更低，且肠功能恢复时间更短。在 48 小时随访评估中，连续伤口输注组完全归因于镇痛方案的中位护士访视次数为 1（四分位距：1-2），硬膜外吗啡组为 8（四分位距：7-10）（95%置信区间差值：6-8 次访视；P<0.001）。
剖宫产术后连续伤口输注罗哌卡因 48 小时与硬膜外吗啡镇痛相比，镇痛效果更好，副作用发生率更低，护理需求更少，住院时间更短。
