Lin Hong-Qi, Jia Dong-Lin
Department of Anesthesiology, the People's Hospital of Henan Province, Zhengzhou, 450003, China.
Department of Pain Treatment, Peking University Third Hospital, Beijing, 100191, China.
J Huazhong Univ Sci Technolog Med Sci. 2016 Aug;36(4):584-587. doi: 10.1007/s11596-016-1629-0. Epub 2016 Jul 28.
The pain following gynecological laparoscopic surgery is less intense than that following open surgery; however, patients often experience visceral pain after the former surgery. The aim of this study was to determine the effects of preemptive ketamine on visceral pain in patients undergoing gynecological laparoscopic surgery. Ninety patients undergoing gynecological laparoscopic surgery were randomly assigned to one of three groups. Group 1 received placebo. Group 2 was intravenously injected with preincisional saline and local infiltration with 20 mL ropivacaine (4 mg/mL) at the end of surgery. Group 3 was intravenously injected with preincisional ketamine (0.3 mg/kg) and local infiltration with 20 mL ropivacaine (4 mg/mL) at the end of surgery. A standard anesthetic was used for all patients, and meperidine was used for postoperative analgesia. The visual analogue scale (VAS) scores for incisional and visceral pain at 2, 6, 12, and 24 h, cumulative analgesic consumption and time until first analgesic medication request, and adverse effects were recorded postoperatively. The VAS scores of visceral pain in group 3 were significantly lower than those in group 2 and group 1 at 2 h and 6 h postoperatively (P<0.05 and P<0.01, respectively). At 2 h and 6 h, the VAS scores of incisional pain did not differ significantly between groups 2 and 3, but they were significantly lower than those in group 1 (P<0.01). Groups 1 and 2 did not show any differences in visceral pain scores at 2 h and 6 h postoperatively. Moreover, the three groups showed no statistically significant differences in visceral and incisional pain scores at 12 h and 24 h postoperatively. The consumption of analgesics was significantly greater in group 1 than in groups 2 and 3, and the time to first request for analgesics was significantly longer in groups 2 and 3 than in group 1, with no statistically significant difference between groups 2 and 3. However, the three groups showed no significant difference in the incidence of shoulder pain or adverse effects. Preemptive ketamine may reduce visceral pain in patients undergoing gynecological laparoscopic surgery.
妇科腹腔镜手术后的疼痛比开腹手术后的疼痛程度轻；然而，患者在前一种手术后常经历内脏痛。本研究的目的是确定预防性使用氯胺酮对接受妇科腹腔镜手术患者内脏痛的影响。90例接受妇科腹腔镜手术的患者被随机分为三组。第1组接受安慰剂。第2组在手术结束时静脉注射术前生理盐水，并局部浸润20 mL罗哌卡因（4 mg/mL）。第3组在手术结束时静脉注射术前氯胺酮（0.3 mg/kg），并局部浸润20 mL罗哌卡因（4 mg/mL）。所有患者均使用标准麻醉剂，术后使用哌替啶进行镇痛。术后记录2、6、12和24小时切口痛和内脏痛的视觉模拟评分（VAS）、累积镇痛药物消耗量、首次要求使用镇痛药物的时间以及不良反应。术后2小时和6小时，第3组内脏痛的VAS评分显著低于第2组和第1组（分别为P<0.05和P<0.01）。在2小时和6小时时，第2组和第3组切口痛的VAS评分无显著差异，但均显著低于第1组（P<0.01）。第1组和第2组术后2小时和6小时内脏痛评分无差异。此外，三组术后12小时和24小时内脏痛和切口痛评分无统计学显著差异。第1组的镇痛药物消耗量显著高于第2组和第3组，第2组和第3组首次要求使用镇痛药物的时间显著长于第1组，第2组和第3组之间无统计学显著差异。然而，三组在肩痛发生率或不良反应方面无显著差异。预防性使用氯胺酮可能减轻接受妇科腹腔镜手术患者的内脏痛。
