Shukla Usha, Prabhakar T, Malhotra Kiran, Srivastava Dheeraj, Malhotra Kriti
Department of Anaesthesiology and Critical Care, U. P. Rural Institute of Medical Sciences and Research, Saifai, Etawah, Uttar Pradesh, India.
Department of Anaesthesiology and Critical Care, Era Medical College, Lucknow, Uttar Pradesh, India.
Indian J Anaesth. 2015 Apr;59(4):234-9. doi: 10.4103/0019-5049.155001.
Intraperitoneal instillation of local anaesthetics has been shown to minimise post-operative pain after laparoscopic surgeries. We compared the antinociceptive effects of intraperitoneal dexmedetomidine or tramadol combined with bupivacaine to intraperitoneal bupivacaine alone in patients undergoing laparoscopic cholecystectomy.
A total of 120 patients were included in this prospective, double-blind, randomised study. Patients were randomly divided into three equal sized (n = 40) study groups. Patients received intraperitoneal bupivacaine 50 ml 0.25% +5 ml normal saline (NS) in Group B, bupivacaine 50 ml 0.25% + tramadol 1 mg/kg (diluted in 5 ml NS) in Group BT and bupivacaine 50 ml 0.25% + dexmedetomidine 1 μg/kg, (diluted in 5 ml NS) in Group BD before removal of trocar at the end of surgery. The quality of analgesia was assessed by visual analogue scale score (VAS). Time to the first request of analgesia, total dose of analgesic in the first 24 h and adverse effects were noted. Statistical analysis was performed using Microsoft (MS) Office Excel Software with the Student's t-test and Chi-square test (level of significance P = 0.05).
VAS at different time intervals, overall VAS in 24 h was significantly lower (1.80 ± 0.36, 3.01 ± 0.48, 4.5 ± 0.92), time to first request of analgesia (min) was longest (128 ± 20, 118 ± 22, 55 ± 18) and total analgesic consumption (mg) was lowest (45 ± 15, 85 ± 35, 175 ± 75) in Group BD than Group BT and Group B.
Intraperitoneal instillation of bupivacaine in combination with dexmedetomidine is superior to bupivacaine alone and may be better than bupivacaine with tramadol.
腹腔内注入局部麻醉药已被证明可使腹腔镜手术后的术后疼痛降至最低。我们比较了腹腔内右美托咪定或曲马多联合布比卡因与单纯腹腔内布比卡因对接受腹腔镜胆囊切除术患者的镇痛效果。
本前瞻性、双盲、随机研究共纳入120例患者。患者被随机分为三个等规模（n = 40）的研究组。B组患者在手术结束拔套管针前接受腹腔内50 ml 0.25%布比卡因+5 ml生理盐水（NS），BT组接受50 ml 0.25%布比卡因+1 mg/kg曲马多（用5 ml NS稀释），BD组接受50 ml 0.25%布比卡因+1 μg/kg右美托咪定（用5 ml NS稀释）。通过视觉模拟量表评分（VAS）评估镇痛质量。记录首次要求镇痛的时间、术后24小时内的镇痛总剂量及不良反应。使用微软（MS）Office Excel软件进行统计分析，采用Student's t检验和卡方检验（显著性水平P = 0.05）。
BD组在不同时间间隔的VAS、24小时总体VAS显著更低（1.80±0.36、3.01±0.48、4.5±0.92），首次要求镇痛的时间（分钟）最长（128±20、118±22、55±18），镇痛总消耗量（mg）最低（45±15、85±35、175±75），优于BT组和B组。
腹腔内注入布比卡因联合右美托咪定优于单纯布比卡因，可能也优于布比卡因联合曲马多。
