Gupta Monika, Naithani Udita, Singariya Geeta, Gupta Sunanda
Senior Resident, Department of Anaesthesia, Sampurnanand Medical College , Jodhpur, Rajasthan, India .
Professor, Department of Anaesthesia, Rabindra Nath Tagore Medical College , Udaipur, Rajasthan, India .
J Clin Diagn Res. 2016 Aug;10(8):UC10-5. doi: 10.7860/JCDR/2016/18845.8309. Epub 2016 Aug 1.
As Laparoscopic Cholecystectomy (LC) is not a totally pain free procedure, with the pain being most intense on the day of surgery and on the following day. Various techniques are available for postoperative pain relief like intraperitoneal instillation of local anaesthetics and rectus sheath block (RSB)which may provide effective pain relief.
To compare the efficacy of preemptive administration (initiated before the surgical procedure) of intraperitoneal instillation and rectus sheath block using ropivacaine for postoperative analgesia after laparoscopic cholecystectomy.
A total of 75 selected patients were randomly assigned to three equal groups as Group R, who received bilateral RSB with 0.25 % ropivacaine 15 ml on either side; Group I, who received intraperitoneal instillation of 0.25% ropivacaine 50 ml and Group C (Control group), who received only rescue analgesic on pain. These were compared regarding postoperative analgesia in terms of Visual Analog Scale (0-10 cm), Prince Henry Hospital Pain Score (0-3), time to first dose of rescue analgesic (tramadol), total rescue analgesic consumption in 48 hours, patient satisfaction scores (1-7) and adverse effects.
The time to first rescue analgesic was significantly longer in Group R (16.16±4.73h) and Group I (7.84±1.34h) as compared to Group C (1.72±0.67h), p<0.001. Mean tramadol consumption in 48h for each patient was significantly less in Group R (148±54.92mg) and Group I (202±33.78mg) as compared to Group C (298±22.73mg) p<0.001. Postoperative pain scores were also significantly less in Group R and Group I as compared to Group C during first 6 hours, p<0.05. The difference in above parameters was also significant between Group R and Group I, p<0.05. Thus order of postoperative analgesia effect was: Group R > Group I > Group C. Rescue analgesic requirement showed a 32.21% reduction in Group I and 50.33% reduction in Group R as compared to Group C. Patient Satisfaction Scores (PSS) showed a significant difference among groups with acceptable PSS scores as: Group R (92%) v/s Group I (40%) v/s Group C (20%) p<0.001.
Pre-emptive administration of rectus sheath block or intraperitoneal instillation of 0.25% ropivacaine was found effective in providing better postoperative analgesia as compared to control group after laparoscopic cholecystectomy. Among these two techniques, rectus sheath block was found to be superior over intraperitoneal instillation.
由于腹腔镜胆囊切除术（LC）并非完全无痛的手术，术后疼痛在手术当天及次日最为剧烈。目前有多种术后疼痛缓解技术，如腹腔内注入局部麻醉药和腹直肌鞘阻滞（RSB），这些方法可能有效缓解疼痛。
比较在腹腔镜胆囊切除术后，术前（手术开始前）使用罗哌卡因进行腹腔内注入和腹直肌鞘阻滞用于术后镇痛的效果。
总共75例入选患者被随机分为三组，每组人数相等。R组患者双侧接受15毫升0.25%的罗哌卡因进行腹直肌鞘阻滞；I组患者接受50毫升0.25%的罗哌卡因腹腔内注入；C组（对照组）仅在疼痛时给予补救性镇痛。比较三组患者术后镇痛的视觉模拟评分（0 - 10厘米）、亨利王子医院疼痛评分（0 - 3）、首次使用补救性镇痛药（曲马多）的时间、48小时内补救性镇痛药的总消耗量、患者满意度评分（1 - 7）及不良反应。
与C组（1.72±0.67小时）相比，R组（16.16±4.73小时）和I组（7.84±1.34小时）首次使用补救性镇痛药的时间显著延长，p<0.001。与C组（298±22.73毫克）相比，R组（148±54.92毫克）和I组（202±33.78毫克）患者48小时内曲马多的平均消耗量显著减少，p<0.001。术后前6小时，R组和I组的疼痛评分也显著低于C组，p<0.05。R组和I组上述参数的差异也具有统计学意义，p<0.05。因此，术后镇痛效果顺序为：R组>I组>C组。与C组相比，I组补救性镇痛药需求量降低了32.21%，R组降低了50.33%。患者满意度评分（PSS）在三组间存在显著差异，可接受的PSS评分如下：R组（92%）对I组（40%）对C组（20%），p<0.001。
与对照组相比，术前进行腹直肌鞘阻滞或腹腔内注入0.25%罗哌卡因在腹腔镜胆囊切除术后能有效提供更好的术后镇痛效果。在这两种技术中，腹直肌鞘阻滞优于腹腔内注入。
