Karaman Semra, Kocabaş Seden, Ergun Sedat, Fırat Vicdan, Uyar Meltem, Şendağ Fatih
Department of Anesthesiology and Reanimation, Ege University Faculty of Medicine, İzmir, Turkey.
Agri. 2012;24(2):56-62. doi: 10.5505/agri.2012.21033.
Postoperative pain after laparoscopic surgery is less intense than after laparotomy and patients may benefit from an intraperitoneal injection of local anesthetic and opioids. We aimed to compare intraperitoneal 0.75% ropivacaine with 0.75% ropivacaine plus meperidine for postoperative analgesia in patients undergoing gynecologic laparoscopy.
At the end of gynecologic laparoscopy, in a double-blind, randomized manner, one of the following injections was given intraperitoneally. Patients were allocated into three groups: Patients in R Group (n=18) were given 0.75% ropivacaine 3 mg/kg in 200 mL saline; patients in RM Group (n=17) were given meperidine 50 mg plus 0.75% ropivacaine 3 mg/kg in 200 mL saline; patients in C Group (n=18) were given 200 mL saline through the trocars. All patients were given diclofenac sodium when they had pain (VAS 3) and 1 mg/kg meperidine i.v. was also given when pain persisted.
The pain scores and analgesic requirements during the first postoperative hour were significantly lower in the RM Group than those in the R and C Groups. Beyond that time, the pain scores were similar in all groups and there were no differences in total analgesic requirement in 24 h between groups. The three groups were comparable for shoulder pain and side effects.
The intraperitoneal infiltration of 0.75% ropivacaine plus meperidine reduced pain scores and analgesic requirement during the first one hour after gynecologic laparoscopy compared with the intraperitoneal infiltration of ropivacaine or saline.
腹腔镜手术后的疼痛强度低于开腹手术后的疼痛强度，患者可能会从腹腔内注射局部麻醉药和阿片类药物中获益。我们旨在比较0.75%罗哌卡因腹腔内注射与0.75%罗哌卡因加哌替啶腹腔内注射用于妇科腹腔镜手术患者术后镇痛的效果。
在妇科腹腔镜手术结束时，采用双盲随机方式进行以下一种注射。患者被分为三组：R组（n = 18）患者在200 mL生理盐水中给予0.75%罗哌卡因3 mg/kg；RM组（n = 17）患者在200 mL生理盐水中给予哌替啶50 mg加0.75%罗哌卡因3 mg/kg；C组（n = 18）患者通过套管针给予200 mL生理盐水。所有患者疼痛时（视觉模拟评分法[VAS]为3）给予双氯芬酸钠，疼痛持续时还静脉注射1 mg/kg哌替啶。
RM组术后第1小时的疼痛评分和镇痛需求显著低于R组和C组。在此之后，所有组的疼痛评分相似，各组24小时内的总镇痛需求无差异。三组在肩部疼痛和副作用方面具有可比性。
与罗哌卡因或生理盐水腹腔内注射相比，0.75%罗哌卡因加哌替啶腹腔内注入可降低妇科腹腔镜手术后第1小时的疼痛评分和镇痛需求。
