Ige Oa, Kolawole Ik, Bolaji Bo
Department of Anaesthesia, University of Ilorin Teaching Hospital, Ilorin, Nigeria.
J West Afr Coll Surg. 2011 Jul;1(3):62-82.
Pain management has traditionally been provided by opioid analgesics. However, the reluctance of some health personnel to prescribe or administer opioids because of the fear of side effects has hindered their use. Local anaesthetic wound infiltration has been shown to improve postoperative pain management.
To determine the efficacy of combined subfascial and subcutaneous infiltration of bupivacaine in providing an opioid- sparing effect following abdominal surgery.
It was a prospective, randomized, double blind, placebo-controlled study.
The study was carried out at the University of Ilorin Teaching Hospital, Ilorin, Nigeria.
The study group received subcutaneous and subfascial infiltration with 40ml of 0.25% bupivacaine while the control group received 40ml of 0.9% saline administered by the surgeon after the closure of the peritoneum. Postoperative analgesia was provided with intramuscular morphine 0.1mg/kg 4hourly on demand and the time to first analgesic request was noted. Intravenous paracetamol was used as rescue analgesia. Postoperative pain was assessed using the verbal rating scale (VRS) at 6, 12 and 24 hours postoperatively at rest and during coughing.
The mean time to first analgesic request was significantly prolonged (p <0.05) in the study group (174 ± 117.6 min) than in the control group (102 ± 84 min). The patients in the control group received more morphine which was not statistically significant (p > 0.05). Request for rescue analgesia and the patients' impression of the analgesia were not significant (Fishers exact test two tailed p-value = 0.7164 and 0.4506 respectively).
Bupicacaine wound infiltration improved pain scores at rest within the first 6 hours and pain scores on coughing within the first 24 hours postoperatively. Although the technique increases the options available for postoperative pain relief after lower abdominal surgery, it cannot be used alone in this type of surgery.
传统上疼痛管理一直通过阿片类镇痛药来进行。然而，一些医护人员因担心副作用而不愿开具或使用阿片类药物，这阻碍了它们的应用。局部麻醉伤口浸润已被证明可改善术后疼痛管理。
确定布比卡因筋膜下和皮下联合浸润在腹部手术后提供阿片类药物节省效应的疗效。
这是一项前瞻性、随机、双盲、安慰剂对照研究。
该研究在尼日利亚伊洛林伊洛林大学教学医院进行。
研究组在腹膜关闭后由外科医生进行皮下和筋膜下40ml 0.25%布比卡因浸润，而对照组接受40ml 0.9%生理盐水。术后按需每4小时肌内注射吗啡0.1mg/kg，并记录首次镇痛需求时间。静脉注射对乙酰氨基酚用作补救性镇痛。术后6、12和24小时在休息和咳嗽时使用视觉模拟评分法（VRS）评估术后疼痛。
研究组首次镇痛需求的平均时间（174±117.6分钟）比对照组（102±84分钟）显著延长（p<0.05）。对照组患者使用更多吗啡，但无统计学意义（p>0.05）。补救性镇痛需求和患者对镇痛的印象无显著差异（Fisher精确检验双侧p值分别为0.7164和0.4506）。
布比卡因伤口浸润改善了术后头6小时的静息疼痛评分和术后头24小时咳嗽时的疼痛评分。尽管该技术增加了下腹部手术后术后疼痛缓解的可用选择，但在这类手术中不能单独使用。
