Department of Surgery, Aga Khan University, Karachi, Pakistan.
J Surg Res. 2012 Dec;178(2):662-9. doi: 10.1016/j.jss.2012.06.005. Epub 2012 Jun 22.
BACKGROUND: Intraperitoneal local anesthetics have been shown to improve postoperative pain after laparoscopic cholecystectomy (LC). However, the choice of local anesthetic agent is debatable. We compared the analgesic efficacy of intraperitoneal lignocaine (lidocaine) versus bupivacaine after elective LC. METHODS: We conducted a double-blind, randomized, controlled trial. We randomized consecutive patients undergoing LC into two groups. Group L received 10 mL 2% lignocaine (lidocaine), whereas Group B received 10 mL 0.5% bupivacaine, each diluted in 10 mL normal saline. All patients underwent standard perioperative anesthesia and analgesia protocol. We assessed patients at 0, 4, 8, 12, and 24 h postoperatively for pain using the visual analogue scale and verbal rating scale, and the need for additional analgesic medications. RESULTS: We analyzed a total of 206 patients: 106 in Group L and 100 in Group B. Demographic details were similar between groups (P > 0.05). Abdominal pain decreased significantly with time in both groups, with a similar mean response profile (P < 0.001). There was no statistically significant difference between groups with regard to abdominal or shoulder pain by both visual analogue scale and verbal rating scale at all five time intervals (P > 0.05). There was also no significant difference in the side effect profile of both drugs (P > 0.05). A lower proportion of patients in Group B required additional narcotic analgesia (87%) compared with Group L (94%). This difference was marginally significant (P = 0.057). CONCLUSIONS: Bupivacaine and lignocaine (lidocaine) are both safe and equally effective at decreasing postoperative pain after LC.
背景:腹腔内局部麻醉剂已被证明可改善腹腔镜胆囊切除术(LC)后的术后疼痛。然而,局部麻醉剂的选择仍存在争议。我们比较了择期 LC 后腹腔内利多卡因(Lidocaine)与布比卡因的镇痛效果。
方法:我们进行了一项双盲、随机、对照试验。我们将接受 LC 的连续患者随机分为两组。L 组接受 10 mL 2%利多卡因(Lidocaine),B 组接受 10 mL 0.5%布比卡因,均稀释于 10 mL 生理盐水。所有患者均接受标准围手术期麻醉和镇痛方案。我们在术后 0、4、8、12 和 24 小时使用视觉模拟评分法和口头评分法评估患者的疼痛,并评估需要额外镇痛药物的情况。
结果:我们共分析了 206 例患者:L 组 106 例,B 组 100 例。两组的人口统计学细节相似(P > 0.05)。两组的腹痛均随时间明显减轻,平均反应曲线相似(P < 0.001)。在所有五个时间间隔,两组的视觉模拟评分法和口头评分法的腹部或肩部疼痛均无统计学差异(P > 0.05)。两种药物的副作用谱也无显著差异(P > 0.05)。B 组需要额外阿片类镇痛药的患者比例(87%)低于 L 组(94%)。这一差异具有统计学意义(P = 0.057)。
结论:布比卡因和利多卡因(Lidocaine)在 LC 后降低术后疼痛方面均安全且同样有效。
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