Evaristo-Méndez Gerardo, García de Alba-García Javier Eduardo, Sahagún-Flores José Ernesto, Ventura-Sauceda Félix Antonio, Méndez-Ibarra Jorge Uriel, Sepúlveda-Castro Rogelio Ricardo
Departamento de Cirugía General, Hospital Regional Dr. Valentín Gómez Farías, ISSSTE. Zapopan, Jalisco, México.
Unidad de Investigación Social, Epidemiológica y en Servicios de Salud, IMSS-Jalisco, México.
Cir Cir. 2013 Sep-Oct;81(5):383-93.
Incisional pain is the main obstacle for elective laparoscopic cholecystectomy as an outpatient. We evaluated the analgesic efficacy of local infiltration of ropivacaine with dexamethasone (Rop/Dx), compared with ropivacaine (Rop) alone, during the first 24 hours postoperative of this surgery. Our hypothesis is that incisional pain intensity will be lower in patients of the group Rop/Dx.
In a randomized, controlled, double-blind trial clinical, 80 patients were divided into two groups. Group Rop (n= 40) received pre and post-incisional infiltration with 150 mg of ropivacaine in 8 mL of 0.9% saline, while group Rop/Dx (n= 40) received 150 mg of ropivacaine with 8 mg of dexamethasone in 6 mL of 0.9% saline. The intensity of pain at rest and movement was assessed at 2, 4, 8, 12 and 24 hours postoperatively by a numerical rating scale of 11 points.
Incisional pain scores in group Rop/Dx were significantly lower, compared to the group Rop, at 12 hours (p= 0.05) and 24 hours (p= 0.01) at rest and at 12 hours (p= 0.04) and 24 hours (p= 0.01) during movement postoperatively.
We found initial evidence that ropivacaine with dexamethasone for local infiltration decreased incisional pain intensity after 12 hours post-elective laparoscopic cholecystectomy with a good safety profile.
切口疼痛是择期腹腔镜胆囊切除术作为门诊手术的主要障碍。我们评估了罗哌卡因与地塞米松局部浸润(Rop/Dx)与单独使用罗哌卡因(Rop)相比,在该手术术后24小时内的镇痛效果。我们的假设是Rop/Dx组患者的切口疼痛强度会更低。
在一项随机、对照、双盲临床试验中,80例患者被分为两组。Rop组(n = 40)在切口前后分别用8 mL 0.9%盐水中的150 mg罗哌卡因进行浸润,而Rop/Dx组(n = 40)在6 mL 0.9%盐水中接受150 mg罗哌卡因与8 mg地塞米松。术后2、4、8、12和24小时通过11分数字评分量表评估静息和活动时的疼痛强度。
术后12小时(p = 0.05)和24小时(p = 0.01)静息时以及术后12小时(p = 0.04)和24小时(p = 0.01)活动时,Rop/Dx组的切口疼痛评分明显低于Rop组。
我们发现初步证据表明,罗哌卡因与地塞米松局部浸润在择期腹腔镜胆囊切除术后12小时后可降低切口疼痛强度,且安全性良好。