Griffiths J D, Nguyen M, Lau H, Grant S, Williams D I
Department of Anaesthesia, Royal Women's Hospital, Melbourne, Victoria, Australia.
Anaesth Intensive Care. 2013 Jan;41(1):46-50. doi: 10.1177/0310057X1304100109.
Pain and postoperative nausea and vomiting (PONV) are common problems after gynaecologic laparoscopy. Two recent studies have shown that morphine requirements and PONV are lower when an LMA ProSeal™ is used, rather than an endotracheal tube (ETT), for female patients undergoing breast and gynaecological surgery. We conducted a patient and observer-blinded randomised controlled trial, recruiting non-obese women without gastro-oesophageal reflux undergoing laparoscopic gynaecological surgery. Patients received a standardised relaxant general anaesthetic and then were randomised to receive either an LMA ProSeal or an endotracheal tube. Patients were assessed at two and 24 hours post-anaesthesia. The primary outcome was postoperative pain score and secondary endpoints included morphine consumption, postoperative emesis and adverse upper airway symptoms. We recruited 116 patients to the study, 57 patients in the ETT group and 59 patients in the LMA ProSeal group. The patients were similar in demographic and surgical characteristics. At two hours, the ETT group was similar to the LMA ProSeal group in regards to pain scores (Visual Analogue Scale 3.0 vs 3.5, P=0.86), morphine consumption (7.2 vs 7.4 mg, P=0.56) and PONV (47.4 vs 47.5%, P=0.99). After 24 hours, pain scores and PONV rates were also similar. No significant difference in rates of sore throat or dysphagia was observed between the ETT and LMA ProSeal groups. No significant complications were attributable to either airway device. The LMA ProSeal did not decrease pain or PONV in patients undergoing gynaecological laparoscopy when compared to endotracheal intubation.
疼痛和术后恶心呕吐（PONV）是妇科腹腔镜手术后的常见问题。最近的两项研究表明，在接受乳房和妇科手术的女性患者中，使用LMA ProSeal™喉罩而不是气管内插管（ETT）时，吗啡需求量和PONV发生率较低。我们进行了一项患者和观察者双盲随机对照试验，招募了接受腹腔镜妇科手术、无胃食管反流的非肥胖女性。患者接受标准化的松弛剂全身麻醉，然后随机接受LMA ProSeal喉罩或气管内插管。在麻醉后2小时和24小时对患者进行评估。主要结局是术后疼痛评分，次要终点包括吗啡消耗量、术后呕吐和上呼吸道不良症状。我们招募了116名患者参与研究，ETT组57例，LMA ProSeal组59例。两组患者在人口统计学和手术特征方面相似。在2小时时，ETT组和LMA ProSeal组在疼痛评分（视觉模拟评分3.0对3.5，P = 0.86）、吗啡消耗量（7.2对7.4 mg，P = 0.56）和PONV发生率（47.4%对47.5%，P = 0.99）方面相似。24小时后，疼痛评分和PONV发生率也相似。ETT组和LMA ProSeal组之间未观察到咽痛或吞咽困难发生率的显著差异。两种气道装置均未导致明显并发症。与气管内插管相比，LMA ProSeal喉罩在接受妇科腹腔镜手术的患者中并未减轻疼痛或降低PONV发生率。
