Department of Anaesthesia and Intensive Care, University of Helsinkiand Helsinki University Central Hospital, Helsinki, Finland.
Int J Obstet Anesth. 2012 Apr;21(2):119-24. doi: 10.1016/j.ijoa.2011.12.009. Epub 2012 Feb 16.
Continuous wound infusion with local anaesthetic has been used in post-caesarean pain management with conflicting results. We carried out a study comparing three groups: continuous ropivacaine wound infusion, intrathecal morphine with saline wound infusion and saline wound infusion only.
Sixty-six women undergoing elective caesarean section under combined spinal-epidural anaesthesia were randomly allocated to receive intrathecal morphine with saline wound infusion or 48 h continuous wound infusion with either ropivacaine or saline. All parturients received oral ketoprofen and intravenous oxycodone patient-controlled analgesia. Consumption of oxycodone, visual analogue scale pain scores (0-10 cm), patient satisfaction, side effects and recovery parameters were recorded for 48 h in a double-blind manner.
Continuous wound infusion with ropivacaine failed to reduce oxycodone consumption or pain scores compared with saline control. In the first 24 h intrathecal morphine reduced mean oxycodone consumption compared to the ropivacaine wound infusion group (26 mg vs. 48 mg, P=0.007) and saline wound infusion group (26 mg vs. 45 mg, P=0.021). The first 24-h mean pain score was also lower in the intrathecal morphine group vs. the saline wound infusion group (1.3 vs. 2.2, P=0.021). Pain scores were not significantly different between intrathecal morphine and ropivacaine wound infusion groups. Pruritus was more common with intrathecal morphine.
Compared to saline control, continuous wound infusion with ropivacaine failed to reduce the use of intravenous oxycodone patient-controlled analgesia or pain scores. Intrathecal morphine decreased oxycodone consumption by 46% in the first 24 h after surgery when compared to continuous ropivacaine wound infusion.
局部麻醉药持续伤口输注已用于剖宫产术后疼痛管理，但结果存在争议。我们进行了一项研究，比较了三组：连续罗哌卡因伤口输注、鞘内吗啡加生理盐水伤口输注和单纯生理盐水伤口输注。
66 例行择期剖宫产术的产妇在蛛网膜下腔-硬膜外联合麻醉下随机分为鞘内吗啡加生理盐水伤口输注组或罗哌卡因或生理盐水 48 小时持续伤口输注组。所有产妇均接受口服酮咯酸和静脉注射羟考酮患者自控镇痛。以双盲方式记录 48 小时内羟考酮的消耗、视觉模拟评分（0-10cm）、患者满意度、副作用和恢复参数。
与生理盐水对照组相比，罗哌卡因持续伤口输注未能减少羟考酮的消耗或疼痛评分。在 24 小时内，鞘内吗啡组与罗哌卡因伤口输注组相比（26mg 对 48mg，P=0.007）和生理盐水伤口输注组（26mg 对 45mg，P=0.021），羟考酮的平均消耗量减少。鞘内吗啡组的前 24 小时平均疼痛评分也低于生理盐水伤口输注组（1.3 对 2.2，P=0.021）。鞘内吗啡组和罗哌卡因伤口输注组的疼痛评分无显著差异。鞘内吗啡组瘙痒更为常见。
与生理盐水对照组相比，罗哌卡因持续伤口输注未能减少静脉注射羟考酮患者自控镇痛的使用或疼痛评分。与连续罗哌卡因伤口输注相比，鞘内吗啡在术后 24 小时内减少了 46%的羟考酮消耗。
