Yari Mitra, Rooshani Bahman, Golfam Parisa, Nazari Nahid
Department of Anesthesia, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran.
Department of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran.
Anesth Pain Med. 2014 Jul 8;4(3):e16710. doi: 10.5812/aapm.16710. eCollection 2014 Aug.
Postoperative nausea and vomiting (PONV) after laparoscopic cholecystectomy (LC) has multifactorial etiology. Pain and use of opioids are among the important factors.
The present study aimed to evaluate the efficacy of intrapritoneal (IP) injection of bupivacaine on PONV.
This was a double-blind randomized clinical trial, conducted on 66 patients aged 20-60, ASA I or II, candidates for LC. Patients were randomly assigned to two groups. Bupivacaine group received 20 mL bupivacaine 0.25% in the gallbladder bed, before and after cholecystectomy and the control group did not. The incidence of nausea and postoperative pain intensity was measured with Visual analogue scale (VAS) at 1, 2, 3 and 4 hours after operation, at rest and when coughing and changing positions. Nausea and vomiting occurrence were assessed at the same times.
There were no demographic data differences between groups. No differences were found between the two groups, in terms of incidence of nausea and vomiting. Furthermore, both groups were similar with respect to opioid consumption, during four hours post-operation.
Intraperitoneal bupivacaine administration at the beginning and end of laparoscopic cholecystectomy reduced only visceral and shoulder pains at the 4th postoperative hour, but had no effect on reducing neither PONV, nor opioid demand, during the first four postoperative hours.
腹腔镜胆囊切除术（LC）后术后恶心呕吐（PONV）病因多方面。疼痛和阿片类药物的使用是重要因素。
本研究旨在评估腹腔内（IP）注射布比卡因对PONV的疗效。
这是一项双盲随机临床试验，对66例年龄在20 - 60岁、ASA I或II级、拟行LC的患者进行。患者随机分为两组。布比卡因组在胆囊切除术前和术后在胆囊床接受20 mL 0.25%布比卡因，对照组未接受。术后1、2、3和4小时、休息时以及咳嗽和改变体位时，用视觉模拟量表（VAS）测量恶心发生率和术后疼痛强度。同时评估恶心和呕吐的发生情况。
两组间人口统计学数据无差异。两组在恶心和呕吐发生率方面无差异。此外，术后四小时内两组在阿片类药物消耗方面相似。
腹腔镜胆囊切除术开始和结束时腹腔内注射布比卡因仅在术后第4小时减轻了内脏和肩部疼痛，但在前四个术后小时内对减少PONV和阿片类药物需求均无作用。
