Jarruwale Phanida, Ingkanart Sirimas, Panichkul Suthee
J Med Assoc Thai. 2016 Aug;99(8):868-76.
To study the effectiveness of intraperitoneal bupivacaine in reducing 24-hour postoperative morphine used in women underwent total abdominal hysterectomy.
Sixty-two non-malignant gynecologic patients, aged 25 to 65 years, ASA class I-II, underwent elective total abdominal hysterectomy. On the operative day, patients were allocated simple random sampling. Blinded intraperitoneal solution was prepared and numbered for each patient. In total, 40 ml of 0.25% bupivacaine solution or normal saline was applied in the pelvic cavity after completed the operation. The abdominal muscle and subcutaneous fat were infiltrated with 0.25% bupivacaine 10 ml each layer. Intravenous morphine patient-controlled analgesia (PCA) was started in the recovery room. The assessment of total morphine used, sedative score, numerical rating score (NRS) for pain, postoperative nausea vomiting (PONV), pruritus, and the number of vomiting and antiemetic drugs used were recorded at 1, 2, 4, 8, 12, and 24 hours after intraperitoneal administration. Patients’ satisfactory NRS was evaluated after PCA cessation. Repeated measure ANOVA was used to compare means between two groups. Baseline characteristics were calculated by descriptive statistics, i.e., mean, standard deviation, median, and range. A p-value less than 0.05 was considered statistically significant. Statistical package for the social sciences (SPSS) for Windows version 23 was used.
There were no significant differences were found between the two groups in general patients’ characteristics, intraoperative data, and anesthetic administration. Total morphine consumption at 24 hours after intraperitoneal administration was significantly less in the bupivacaine group than the saline group (25.03 vs. 16.13, p = 0.002). Lower pain score at 1 and 2 hours and significant difference in reduced morphine consumption were observed within the first 4 hours after intraperitoneal bupivacaine administration. Postoperative 24 hours satisfactory score, PONV, pruritic score, overall incidences of vomiting and antiemetic use were similar in both groups. Sedative scores were lower in the bupivacaine group except at 1 and 24 hours postintraperitoneal administration. No evidence of local anesthetic toxicity or operative complication was identified.
Administration of intraperitoneal and incisional 0.25% bupivacaine at the completion of total abdominal hysterectomy produced a significant reduction in 24-hour postoperative morphine used without adverse effect.
研究布比卡因腹腔内给药对接受全腹子宫切除术的女性术后24小时吗啡用量的影响。
62例年龄在25至65岁、ASA分级为I-II级的非恶性妇科患者接受择期全腹子宫切除术。手术当天，患者通过简单随机抽样进行分组。为每位患者制备并编号了盲法腹腔内溶液。手术结束后，在盆腔内注入40毫升0.25%布比卡因溶液或生理盐水。每层腹壁肌肉和皮下脂肪各浸润10毫升0.25%布比卡因。在恢复室开始静脉注射吗啡患者自控镇痛（PCA）。记录腹腔内给药后1、2、4、8、12和24小时的吗啡总用量、镇静评分、疼痛数字评分（NRS）、术后恶心呕吐（PONV）、瘙痒情况以及呕吐次数和使用的止吐药物数量。PCA停止后评估患者的NRS满意度。采用重复测量方差分析比较两组均值。通过描述性统计计算基线特征，即均值、标准差、中位数和范围。p值小于0.05被认为具有统计学意义。使用Windows版社会科学统计软件包（SPSS）23。
两组患者的一般特征、术中数据和麻醉用药情况无显著差异。布比卡因组腹腔内给药后24小时的吗啡总消耗量显著低于生理盐水组（25.03对16.13，p = 0.002）。腹腔内注射布比卡因后1至2小时疼痛评分较低，且在最初4小时内吗啡消耗量减少有显著差异。两组术后24小时满意度评分、PONV、瘙痒评分、呕吐总发生率和止吐药使用情况相似。布比卡因组除腹腔内给药后1小时和24小时外，镇静评分较低。未发现局部麻醉药毒性或手术并发症的证据。
全腹子宫切除术后腹腔内和切口处给予0.25%布比卡因可显著减少术后24小时吗啡用量且无不良反应。
