Liu Hui-li, Ma Cai-hong, Zhang Xiao-qing, Yang Yan, Song Xue-ling, Guo Xiang-yang
Department of Anesthesiology, Peking University Third Hospital, Beijing 100191, China.
Reproductive Medicine Center, Peking University Third Hospital, Beijing 100191, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2013 Dec 18;45(6):901-5.
To evaluate the combined effect of premedication of parecoxib sodium and local infiltration of ropivocaine on postoperative shoulder pain and incisional pain in patients undergoing diagnostic hysteroscopy and laparoscopy.
In the study, 60 patients undergoing elective diagnostic hysteroscopy and laparoscopy were randomly allocated to two groups (each with 30 patients). The patients in group 1 were premedicated with 40 mg parecoxib sodium (diluted with 2 mL normal saline), and 0.5% ropivacaine (20 mL) were infiltrated around the incision site before establishment of CO2 pneumoperitoneum. The patients in group 2 received 2 mL normal saline intraveniously before anesthesia induction, and infiltration of 0.5% ropivacaine 20 mL were also applied as group 1. After anesthetic withdrawal, the patients' postoperative anesthesia recovery time and the time point of opening eyes on verbal command were noted. The intensities of postoperative shoulder pain and incisional pain were evaluated at 0, 2, 4, 8, 12, 24, and 48 h after surgery. The postoperative analgesic requirement was met by administration of tramadol.
Compared with group 2, the incidence of postoperative shoulder pain was less in group 1 (37% vs. 67%, P=0.020), and the occurence of severe pain was lower (4 vs. 11, P=0.037). The numerical rating scales (NRS) of right shoulder pain of group 1 were significantly reduced than those of group 2 at 12 h postoperatively [0 (0, 2) vs. 0 (0, 8), P=0.012]. Left shoulder pain did not appear at 0 h and 2 h in both groups, while at 12 h and 24 h postoperatively, the NRS scores of group 1 were lower than those of group 2 [0 (0, 1) vs. 0 (0, 8), P=0.026; 0 (0, 4) vs. 2 (0, 9), P=0.014]. The dynamic and static abdominal pain scores of group 1 were significantly decreased than those of group 2 in post-anesthesia care unit (PACU) after surgery (P=0.001, P=0.005). The NRS scores of static abdominal pain of group 1 were significantly reduced than those of group 2 at 12 h and 24 h postoperatively (P=0.042, P=0.029). More patients in group 2 needed tramadol within 24 h postoperatively (8 vs. 0, P=0.002).
Premedication of parecoxib sodium combined with local infiltration of ropinvocaine before incision could significantly reduce the postoperative shoulder pain and incisional pain as well as reduce opioid consumption in patients undergoing diagnostic hysteroscopy and laparoscopy.
评估帕瑞昔布钠预处理与罗哌卡因局部浸润联合应用对诊断性宫腔镜及腹腔镜手术患者术后肩部疼痛和切口疼痛的综合影响。
本研究中，60例行择期诊断性宫腔镜及腹腔镜手术的患者被随机分为两组（每组30例）。第1组患者术前静脉注射40mg帕瑞昔布钠（用2ml生理盐水稀释），并在建立二氧化碳气腹前于切口周围浸润0.5%罗哌卡因20ml。第2组患者在麻醉诱导前静脉注射2ml生理盐水，并同第1组一样浸润0.5%罗哌卡因20ml。麻醉苏醒后，记录患者术后麻醉恢复时间及能按指令睁眼的时间点。于术后0、2、4、8、12、24及48小时评估患者术后肩部疼痛和切口疼痛的强度。术后通过给予曲马多满足镇痛需求。
与第2组相比，第1组术后肩部疼痛的发生率较低（37% 对67%，P = 0.020），且重度疼痛的发生率较低（4例对11例，P = 0.037）。术后12小时，第1组右肩部疼痛的数字评分量表（NRS）显著低于第2组[0（0，2）对0（0，8），P = 0.012]。两组在术后0小时和2小时均未出现左肩部疼痛，而在术后12小时和24小时，第1组的NRS评分低于第2组[0（0，1）对0（0，8），P = 0.026；0（0，4）对2（0，9），P = 0.014]。术后在麻醉后恢复室（PACU），第1组的动态和静态腹痛评分均显著低于第2组（P = 0.001，P = 0.005）。术后12小时和24小时，第1组的静态腹痛NRS评分显著低于第2组（P = 0.042，P = 0.029）。第2组更多患者在术后24小时内需要使用曲马多（8例对0例，P = 0.002）。
术前帕瑞昔布钠预处理联合切口前罗哌卡因局部浸润可显著减轻诊断性宫腔镜及腹腔镜手术患者的术后肩部疼痛和切口疼痛，并减少阿片类药物的用量。
