Upadya M, Pushpavathi S H, Seetharam Kaushik Rao
Department of Anaesthesia, Kasturba Medical College, Manipal University, Mangalore, India.
Department of Anaesthesia, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India.
Anesth Essays Res. 2015 Jan-Apr;9(1):39-43. doi: 10.4103/0259-1162.150154.
Nonsteroidal anti-inflammatory drugs used for postoperative analgesia have considerable adverse effects, with paracetamol having a different mechanism of action, superior side effect profile and availability in intravenous (IV) form, this study was conducted to compare intra-peritoneal bupivacaine with IV paracetamol for postoperative analgesia following laparoscopic cholecystectomy.
The aim was to compare the efficacy of intra-peritoneal administration of bupivacaine 0.5% and IV acetaminophen for postoperative analgesia in patients undergoing laparoscopic cholecystectomy.
Randomized, prospective trial.
A total of 60 patients of American Society of Anesthesiologists physical Status I and II scheduled for laparoscopic cholecystectomy were enrolled for this study. Group I received 2 mg/kg of 0.5% bupivacaine as local intra-peritoneal application and Group II patients received IV 1 g paracetamol 6(th) hourly. Postoperatively, the patients were assessed for pain utilizing Visual Analog Scale (VAS), Visual Rating Prince Henry Scale (VRS), shoulder pain. The total number of patients requiring rescue analgesia and any side-effects were noted.
Data analysis was performed using Students unpaired t-test. SPSS version 11.5 was used.
The VAS was significantly higher in Group I compared with Group II at 8(th), 12(th) and 24(th) postoperative hour. At 1(st) and 4(th) postoperative hours, VAS was comparable between the two groups. Although the VRS was higher in Group I compared with Group II at 12(th) and 24(th) postoperative hour; the difference was statistically significant only at 24(th) postoperative hour. None of the patients in either of the groups had shoulder pain up to 8 h postoperative. The total number of patients requiring analgesics was higher in Group II than Group I at 1(st) postoperative hour.
Although local anesthetic infiltration and intra-peritoneal administration of 0.5% bupivacaine decreases the severity of incisional, visceral and shoulder pain in the early postoperative period, IV paracetamol provides sustained pain relief for 24 postoperative hours after elective laparoscopic cholecystectomy.
用于术后镇痛的非甾体类抗炎药有相当多的不良反应，对乙酰氨基酚作用机制不同，副作用较小且有静脉注射剂型，本研究旨在比较腹腔镜胆囊切除术后腹腔注射布比卡因与静脉注射对乙酰氨基酚的镇痛效果。
比较0.5%布比卡因腹腔注射与静脉注射对乙酰氨基酚对腹腔镜胆囊切除术患者术后镇痛的效果。
随机、前瞻性试验。
本研究共纳入60例美国麻醉医师协会身体状况分级为I级和II级、计划行腹腔镜胆囊切除术的患者。第一组局部腹腔注射2mg/kg的0.5%布比卡因，第二组患者每6小时静脉注射1g对乙酰氨基酚。术后，采用视觉模拟评分法（VAS）、视觉评级亨利王子评分法（VRS）、肩部疼痛评估患者疼痛情况。记录需要补救镇痛的患者总数及任何副作用。
采用学生氏非配对t检验进行数据分析。使用SPSS 11.5版软件。
术后第8、12和24小时，第一组的VAS显著高于第二组。术后第1和4小时，两组的VAS相当。虽然术后第12和24小时第一组的VRS高于第二组，但差异仅在术后第24小时有统计学意义。两组患者术后8小时内均无肩部疼痛。术后第1小时，第二组需要镇痛药的患者总数高于第一组。
虽然局部麻醉药浸润和腹腔注射0.5%布比卡因可减轻术后早期切口、内脏和肩部疼痛的严重程度，但静脉注射对乙酰氨基酚可为择期腹腔镜胆囊切除术后24小时提供持续的疼痛缓解。
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