Mahomed Kassam, McLean Jim, Ahmed Muhtashim, Zolotarev Boris, Shaddock Natalie
Department of Obstetrics and Gynaecology, Ipswich Hospital and University of Queensland, Ipswich, Queensland, Australia.
Department of Anaesthetics, Ipswich Hospital, Ipswich, Queensland, Australia.
Aust N Z J Obstet Gynaecol. 2016 Oct;56(5):484-488. doi: 10.1111/ajo.12498. Epub 2016 Jun 30.
Pain after hysteroscopy is usually minimal but some women need additional analgesia while in the recovery ward and some require overnight hospital admission to control pain. Intrauterine installation of an anaesthetic after hysteroscopy may reduce pain.
To see if intrauterine levobupivacaine reduces post-procedure pain, need for analgesia and allow earlier return to normal activity.
This was a double-blind randomised controlled trial. Women having hysteroscopy under general anaesthesia were allocated to receive intrauterine instillation of levubupivacaine or normal saline at the end of the procedure. Women were assessed in the recovery ward by a verbal descriptor pain scale and need for additional analgesia and followed up on day 3 to further assess pain and return to normal activity.
There were no significant differences in demographic characteristics or indication for surgery between the 224 women in the study group or the 214 women in the control group. At two hours post-procedure, 156/224 (70%) study women versus 119/214 (56%) control women had no pain; (relative risk (RR) 0.68 and 95% confidence interval (CI) 0.53-0.87). There were 182/224 (81%) study women versus 154/214 (72%) control women with a pain score < 5 (RR 0.67; 95% CI 0.47-0.95). Fewer women in the study group required additional analgesia 54/224 (24%) versus 88/214 (41%) (RR 0.58; 95% CI 0.44-0.78). There was no significant difference between groups with regards to pain at 24 h post-procedure or return to activity.
Intrauterine instillation of levobupivacaine reduced post-procedure pain and need for additional pain relief.
宫腔镜检查后的疼痛通常很轻微，但一些女性在恢复病房需要额外的镇痛措施，还有一些女性需要住院过夜以控制疼痛。宫腔镜检查后在子宫内注入麻醉剂可能会减轻疼痛。
观察子宫内左旋布比卡因是否能减轻术后疼痛、减少镇痛需求并使患者更早恢复正常活动。
这是一项双盲随机对照试验。在全身麻醉下进行宫腔镜检查的女性在手术结束时被分配接受子宫内注入左旋布比卡因或生理盐水。在恢复病房通过语言描述疼痛量表对女性进行评估，并评估其对额外镇痛的需求，在第3天进行随访以进一步评估疼痛情况和恢复正常活动的情况。
研究组的224名女性与对照组的214名女性在人口统计学特征或手术指征方面无显著差异。术后两小时，156/224（70%）的研究组女性与119/214（56%）的对照组女性无疼痛；（相对危险度（RR）0.68，95%置信区间（CI）0.53 - 0.87）。疼痛评分<5的研究组女性有182/224（81%），对照组女性有154/214（72%）（RR 0.67；95% CI 0.47 - 0.95）。研究组需要额外镇痛的女性较少，为54/224（24%），而对照组为88/214（41%）（RR 0.58；95% CI 0.44 - 0.78）。两组在术后24小时的疼痛情况或恢复活动方面无显著差异。
子宫内注入左旋布比卡因可减轻术后疼痛并减少对额外镇痛的需求。
