Kim Jung Eun, Shim Seung-Hyuk, Dong Meari, Lee Hyojin, Hwang Han Sung, Kwon Han Sung, Lee Sun Joo, Lee Ji Young, Sohn In Sook, Kim Soo-Nyung, Kang Soon-Beom
Department of Obstetrics and Gynecology, Konkuk University School of Medicine, Seoul, Korea.
Obstet Gynecol Sci. 2017 Sep;60(5):455-461. doi: 10.5468/ogs.2017.60.5.455. Epub 2017 Sep 18.
To determine whether local bupivacaine injection into the incision site after gynecologic laparoendoscopic single site surgery (LESS) improves postoperative pain.
This prospective cohort study included consecutive 158 patients who had LESS for benign adnexal disease from March 2013 to December 2015. Chronologically, 82 patients (March 2013 to August 2014) received no bupivacaine (group 1) and 76 (August 2014 to December 2015) received a bupivacaine block (group 2). For group 2, 10 mL 0.25% bupivacaine was injected into the 20 mm-incision site through all preperitoneal layers after LESS completion. Primary outcome is postoperative pain score using the visual analog scale (VAS).
There was no difference in clinicopathological characteristics between the groups. Operating time (expressed as median [range], 92 [55-222] vs. 100 [50-185] minutes, =0.137) and estimated blood loss (50 [30-1,500] vs. 125 [30-1,000] mL, =0.482) were similar between the groups. Post-surgical VAS pain scores after 3 hours (3.5 [2-6] vs. 3.5 [2-5], =0.478), 6 to 8 hours (3.5 [2-6] vs. 3 [1-8], =0.478), and 16 to 24 hours (3 [2-4] vs. 3 [1-7], =0.664) did not differ between groups.
Bupivacaine injection into the trocar site did not improve postoperative pain after LESS. Randomized trials are needed to evaluate the benefits of local bupivacaine anesthetic for postoperative pain reduction.
确定妇科腹腔镜单孔手术（LESS）后在切口部位局部注射布比卡因是否能改善术后疼痛。
这项前瞻性队列研究纳入了2013年3月至2015年12月期间因良性附件疾病接受LESS手术的158例连续患者。按时间顺序，82例患者（2013年3月至2014年8月）未接受布比卡因（第1组），76例患者（2014年8月至2015年12月）接受布比卡因阻滞（第2组）。对于第2组，LESS完成后，通过所有腹膜前层将10 mL 0.25%布比卡因注入20 mm切口部位。主要结局是使用视觉模拟量表（VAS）评估的术后疼痛评分。
两组患者的临床病理特征无差异。两组的手术时间（以中位数[范围]表示，92 [55 - 222]分钟对100 [50 - 185]分钟，P = 0.137）和估计失血量（50 [30 - 1500] mL对125 [30 - 1000] mL，P = 0.482）相似。术后3小时（3.5 [2 - 6]对3.5 [2 - 5]，P = 0.478）、术后6至8小时（3.5 [2 - 6]对3 [1 - 8]，P = 0.478）以及术后16至24小时（3 [2 - 4]对3 [1 - 7]，P = 0.664）的VAS疼痛评分在两组之间无差异。
LESS术后在套管针部位注射布比卡因并不能改善术后疼痛。需要进行随机试验来评估局部布比卡因麻醉对减轻术后疼痛的益处。
