Moss G, Regal M E, Lichtig L
Surgery. 1986 Feb;99(2):206-10.
Bupivacaine wound infiltration together with efficient esophagogastric decompression and immediate elemental feeding in 43 consecutive, well-instructed patients who had undergone cholecystectomy reduced their postoperative analgesia requirements to an average of 17 (+/- 46, SD) mg of meperidine during the initial 24 hours. No analgesics were requested by 35/43 patients (81%) and 40/43 were discharged within 24 hours of surgery. All 86 conventionally treated control patients required narcotics, averaging 4.4 (+/- 0.3, SD) doses and amounting to 290 (+/- 25, SD) mg of meperidine or its equivalent during their first postoperative day and were discharged in 6.5 (+/- 0.7, SD) days. None were discharged in less than 3 days. Home interview by a visiting nurse was carried out for a block of 19 treated patients and their families. Six patients were interviewed prospectively within 33 to 64 hours of surgery, with a repeat visit 1 to 2 months later. Retrospectively studied patients were only seen 1 to 4 months after surgery. These interviews confirmed the patients' and their families' satisfaction with their bodily functions, their limited discomfort, and their independence from the hospital. Wound infiltration with a long-acting local anesthetic, efficient removal of swallowed air, and immediate, full enteral nutrition contribute to reduced postoperative pain and narcotic use in well-instructed patients, thus leading to safe and satisfactory early discharge.
在43例连续接受胆囊切除术且得到良好指导的患者中，布比卡因伤口浸润联合有效的食管胃减压及立即给予要素饮食，使他们术后最初24小时内哌替啶的平均镇痛需求量降至17（±46，标准差）mg。43例患者中有35例（81%）未要求使用镇痛药，43例中有40例在术后24小时内出院。所有86例接受传统治疗的对照患者均需要使用麻醉药，术后第一天平均需要4.4（±0.3，标准差）剂，相当于290（±25，标准差）mg哌替啶或其等效药物，且在6.5（±0.7，标准差）天出院。无一例在术后3天内出院。对一组19例接受治疗的患者及其家属进行了家访。6例患者在术后33至64小时接受了前瞻性访谈，1至2个月后进行了回访。对回顾性研究的患者仅在术后1至4个月进行了访谈。这些访谈证实了患者及其家属对身体功能、轻微不适以及无需住院的满意度。长效局部麻醉药伤口浸润、有效清除吞咽气体以及立即给予全肠内营养有助于减少接受良好指导患者的术后疼痛和麻醉药使用，从而实现安全且令人满意的早期出院。
