Gherghinescu M C, Copotoiu C, Lazar A E, Popa D, Mogoanta S S, Molnar C
Department M5, Surgery 1, Emergency Clinical County Hospital of Tirgu Mures, Clinic Surgery 1, University of Medicine and Pharmacy Tirgu Mures, 50, Gheorghe Marinescu St., 540136, Tirgu Mures, Romania.
Clinic of Anaesthesiology and Intensive Care, Department M4, Anaesthesiology and Intensive Care II, Emergency Clinical County Hospital of Tirgu Mures, University of Medicine and Pharmacy Tirgu Mures, 50, Gheorghe Marinescu St., 540136, Tirgu Mures, Romania.
Hernia. 2017 Oct;21(5):677-685. doi: 10.1007/s10029-017-1625-8. Epub 2017 May 30.
Incisional hernias are a frequent complication of laparotomy. Open surgery is still an option for the treatment of incisional hernias with medium and large wall defects. Major opioids are routinely used in the treatment of postoperative pain, with several side effects. Continuous local analgesia can be effective in postoperative pain management after various surgical interventions. However, very few reports exist on its application in incisional hernias.
We assessed the effectiveness of ropivacaine in reducing the need for systemic analgesics in postoperative pain management related to these interventions.
We conducted an open-label, prospective, randomized design study. One hundred patients with medium and large incisional hernias were treated by open surgery. Thirty patients with abdominal defects > 8 cm received continuous postoperative local analgesia with ropivacaine 5 mg/ml. Thirty four and 36 patients (abdominal defects of more, and respectively less than 8 cm) received conventional analgesia.
Continuous local anesthesia during the first 72 h after surgery reduced the number of patients needing analgesia with pethidine (17 vs 47% and 53%, p = 0.006), as well as the cumulative doses of pethidine (p < 0.05), tramadol (p < 0.001), and metamizole (p < 0.001) needed to control postoperative pain. Catheter installation for local anesthesia did not increase surgery time (p = 0.16) or the rate of local complications.
Continuous local analgesia reduces the need for systemic opioids and can be successfully used in the postoperative pain management after medium and large incisional hernias treated by open surgery.
切口疝是剖腹手术常见的并发症。开放手术仍是治疗中大型腹壁缺损切口疝的一种选择。主要阿片类药物常用于术后疼痛治疗，但存在多种副作用。连续局部镇痛在各种外科手术后的疼痛管理中可能有效。然而，关于其在切口疝中的应用报道极少。
我们评估了罗哌卡因在减少这些干预相关术后疼痛管理中全身镇痛药需求方面的有效性。
我们进行了一项开放标签、前瞻性、随机设计研究。100例中大型切口疝患者接受开放手术治疗。30例腹部缺损>8 cm的患者术后接受5 mg/ml罗哌卡因连续局部镇痛。34例和36例患者（腹部缺损分别大于和小于8 cm）接受传统镇痛。
术后72小时内连续局部麻醉减少了需要哌替啶镇痛的患者数量（分别为17% vs 47%和53%，p = 0.006），以及控制术后疼痛所需的哌替啶（p < 0.05）、曲马多（p < 0.001）和安乃近（p < 0.001）的累积剂量。局部麻醉置管未增加手术时间（p = 0.16）或局部并发症发生率。
连续局部镇痛减少了全身阿片类药物的需求，可成功用于开放手术治疗的中大型切口疝术后疼痛管理。
