Bindra Tripat Kaur, Kumar Parmod, Rani Parul, Kumar Ashwani, Bariar Hardeep
Department of Anaesthesia and Critical Care, Government Medical College, Patiala, Punjab, India.
Department of Surgery, Government Medical College, Patiala, Punjab, India.
Anesth Essays Res. 2017 Jul-Sep;11(3):740-744. doi: 10.4103/aer.AER_7_17.
Preemptive analgesia has the potential to be more effective than a similar analgesic treatment initiated after surgery as it reduces immediate postoperative pain as well as chronic pain.
To study the efficacy of preemptive analgesia with intraperitoneal instillation of ropivacaine in laparoscopic cholecystectomy (LC).
This prospective randomized double-blind study was conducted on patients undergoing LC. Hundred patients were randomly divided into two groups of fifty each. In Group A, patients received 3 mg/kg of ropivacaine intraperitoneal instillation in 100 ml normal saline (NS) before creation of pneumoperitoneum and in Group B patients received 3 mg/kg of ropivacaine intraperitoneal instillation in 100 ml NS after completion of surgery. Postoperative visual analog scale score for abdominal and shoulder tip pain alongwith requirement of rescue analgesic were recorded for 24 h.
Significantly lower visual analog scores for pain were observed in Group A versus Group B. Group A reported significantly lower pain at 0 h ( < 0.001), 1 h ( = 0.003), 3 h ( = 0.006), 6 h ( = 0.003), and 12 h ( = 0.001) postoperatively, but the difference was not statistically significant after 12 h. The mean time of first rescue analgesic was 472.8 ± 26.32 min in Group A, as compared with 189 ± 11.87 min in Group B. A significantly lower analgesic requirement was observed in Group A versus Group B throughout the entire study period ( < 0.05).
The preemptive analgesia with intraperitoneal instillation of ropivacaine before creation of pneumoperitoneum is much more effective for postoperative pain relief in comparison to intraperitoneal instillation of ropivacaine after completion of surgery.
超前镇痛有可能比术后开始的类似镇痛治疗更有效，因为它能减轻术后即刻疼痛以及慢性疼痛。
研究腹腔镜胆囊切除术（LC）中腹腔内注入罗哌卡因进行超前镇痛的疗效。
对接受LC的患者进行了这项前瞻性随机双盲研究。100例患者被随机分为两组，每组50例。A组患者在建立气腹前，于100ml生理盐水中腹腔内注入3mg/kg罗哌卡因，B组患者在手术完成后于100ml生理盐水中腹腔内注入3mg/kg罗哌卡因。记录术后24小时腹部和肩部尖端疼痛的视觉模拟评分以及急救镇痛药的使用情况。
与B组相比，A组的疼痛视觉模拟评分显著更低。A组术后0小时（<0.001）、1小时（=0.003）、3小时（=0.006）、6小时（=0.003）和12小时（=0.001）的疼痛显著更低，但12小时后差异无统计学意义。A组首次使用急救镇痛药的平均时间为472.8±26.32分钟，而B组为189±11.87分钟。在整个研究期间，A组的镇痛需求显著低于B组（<0.05）。
与手术完成后腹腔内注入罗哌卡因相比，在建立气腹前腹腔内注入罗哌卡因进行超前镇痛对术后疼痛缓解更有效。
