Ayman M, Materazzi G, Bericotti M, Rago R, Nidal Y, Miccoli P
Department of General Surgery, Faculty of Medicine, University of Jordan, Amman, Jordan.
Minerva Chir. 2012 Dec;67(6):511-6.
Control of postoperative pain is one of the most important concerns for both the patients and the surgical team. In this regard the efficacy of wound infiltration with local analgesia and the most proper drugs to be used are not settled. We conducted our study trying to investigate this point in a prospective randomized double blinded manner.
With inclusion criteria of: age (18-65 y), volume <90 mL, first time, no lymph node enlargement and exclusion criteria of: duration >90 min, incision length >10 cm, neck dissection decided during surgery and a postoperative complication within the first 24 hours. Sixty patients planned for total thyroidectomy under general anesthesia were enrolled in the study in three groups with twenty patients assigned randomly to each one: group (A) a control group in which no wound infiltration was done, group (B) in which preoperative wound infiltration with 10 mL bupivacaine 0.5% was done, and group (C) in which preoperative wound infiltration with 10 mL ropivacaine 0.75% was done. Postoperative pain was evaluated by Visual Analogue Score (VAS) with a scale of (0-10) at 1 hour, 4 hours, 8 hours and 16 hours.
The postoperative pain experienced by all the patients reached a maximum point at 1 hour postoperatively then started to decrease to be minimal at 8 hours and almost negligible at 16 hours. Ropivacaine group showed a statistically significant decrease in pain perception at 1 hour postoperatively (P=0.028), bupivacaine group showed also a decrease in pain perception at 1 hour but it was not statistically significant. At 4 hours of operation and after; neither ropivacaine nor bupivacaine showed an effect on pain perception.
The benefit of local wound infiltration with local analgesia in decreasing postoperative pain is limited to a short period after surgery in which the use of ropivacaine 0.75% is recommended over pubivaccaine 0.5%.
控制术后疼痛是患者和手术团队最为关注的问题之一。在这方面，局部镇痛伤口浸润的疗效以及最适合使用的药物尚无定论。我们以前瞻性随机双盲的方式开展研究以探讨这一问题。
纳入标准为：年龄（18 - 65岁）、体积<90 mL、首次手术、无淋巴结肿大；排除标准为：手术持续时间>90分钟、切口长度>10 cm、术中决定行颈部清扫术以及术后24小时内出现并发症。60例计划在全身麻醉下行甲状腺全切除术的患者被纳入研究，分为三组，每组20例：A组为对照组，未进行伤口浸润；B组术前用10 mL 0.5%布比卡因进行伤口浸润；C组术前用10 mL 0.75%罗哌卡因进行伤口浸润。术后疼痛通过视觉模拟评分（VAS）（0 - 10分）在术后1小时、4小时、8小时和16小时进行评估。
所有患者术后疼痛在术后1小时达到最高点，然后开始下降，在8小时降至最低，在16小时几乎可忽略不计。罗哌卡因组术后1小时疼痛感觉有统计学显著下降（P = 0.028），布比卡因组术后1小时疼痛感觉也有下降，但无统计学显著性。手术4小时及以后，罗哌卡因和布比卡因对疼痛感觉均无影响。
局部镇痛伤口浸润在减轻术后疼痛方面的益处仅限于术后短时间内，在此期间，推荐使用0.75%罗哌卡因而非0.5%布比卡因。
