Labrum Joseph T, Ilyas Asif M
Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville,Tennessee, United States.
Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, United States.
J Hand Microsurg. 2017 Aug;9(2):80-83. doi: 10.1055/s-0037-1603734. Epub 2017 Jun 5.
Currently no guidelines exist for the timing of the injection of anesthetics in surgeries performed under general anesthesia to minimize postoperative pain. To better understand the role of timing of the injection of local anesthesia in hand surgery performed under general anesthesia, we evaluated the effect of pre- versus postincisional local analgesic injection on immediate postoperative pain experience. We hypothesize that the preincisional (preemptive) injection will result in decreased immediate postoperative pain experience and analgesic use when compared with postincisional injection. Consecutive cases of thumb basal joint arthroplasty performed over a 4-year period were retrospectively reviewed. During the first half of the study period, the surgical site was infiltrated with 0.5% bupivacaine at the completion of surgery following closure. During the second half of the study period, the surgical site was infiltrated with 0.5% bupivacaine prior to skin incision. Data collected included patient demographics, immediate postoperative recovery room (PACU) pain scores, and postoperative opioid consumption in morphine equivalents. Two-tailed -test identified no significant difference between the pre- and postincision cohorts relative to PACU entrance pain scores and time spent in the PACU. PACU exit pain scores were significantly lower in the preincision cohort. The mean PACU pain score was also significantly lower in the preincision cohort. PACU opioid consumption, converted into morphine equivalents, was found to be 211 mg in the preincision versus 299 mg in the postincision cohort. The preincisional (preemptive) injection of local anesthesia was found to result in lower pain scores during and upon exit of the PACU as compared with the postclosure group. In addition, the preincision cohort also trended toward lower opioid consumption while in the PACU. Consideration should be given to the routine use of preincision injection of local anesthesia to maximize pain relief in a multimodal pain strategy in hand surgical patients. Therapeutic level III.
目前，对于全身麻醉下手术中注射麻醉剂的时机尚无指南，以尽量减少术后疼痛。为了更好地理解全身麻醉下手部手术中局部麻醉注射时机的作用，我们评估了切口前与切口后局部镇痛注射对术后即刻疼痛体验的影响。我们假设，与切口后注射相比，切口前（预防性）注射将减少术后即刻疼痛体验和镇痛药物的使用。 回顾性分析了4年期间连续进行的拇指掌指关节置换病例。在研究期的前半段，手术结束缝合后，手术部位用0.5%布比卡因浸润。在研究期的后半段，在皮肤切口前，手术部位用0.5%布比卡因浸润。收集的数据包括患者人口统计学资料、术后即刻恢复室（PACU）疼痛评分以及术后吗啡当量的阿片类药物消耗量。 双尾t检验显示，切口前和切口后两组在PACU入口疼痛评分和在PACU停留时间方面无显著差异。切口前组的PACU出口疼痛评分显著更低。切口前组的平均PACU疼痛评分也显著更低。将PACU阿片类药物消耗量换算为吗啡当量后，发现切口前组为211mg，而切口后组为299mg。 与缝合后组相比，发现切口前（预防性）注射局部麻醉可使PACU期间及离开时的疼痛评分更低。此外，切口前组在PACU期间的阿片类药物消耗量也有降低趋势。在手外科患者的多模式疼痛策略中，应考虑常规使用切口前局部麻醉注射以最大程度缓解疼痛。 治疗性III级。
