Ammianickal Pooja Lal, Thangaswamy Chitra Rajeswari, Balachander Hemavathi, Subbaiah Murali, Kumar N C Pankaj
Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
Department of Obstetric and Gynaecology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
Indian J Anaesth. 2018 Oct;62(10):759-764. doi: 10.4103/ija.IJA_124_18.
Continuous wound infiltration (CWI) is emerging as an alternative to continuous epidural infusion (CEI). This study compared postoperative pain scores of CEI with CWI in patients undergoing total abdominal hysterectomy (TAH).
This prospective randomised controlled trial included 102 patients planned for TAH who were randomised into either Group E (CEI) or Group L (CWI). The catheter (epidural/wound infiltration) was inserted in Group E before induction) and Group L at the end of surgery. General anaesthesia was administered according to standard protocol. At the end of surgery, both groups received 10 mL bolus of 0.2% ropivacaine followed by infusion at 6 mL/h through the respective catheters. They also received intravenous patient-controlled analgesia with morphine. The primary outcome was the visual analogue score at rest (VAS) and at deep breathing (VAS) post-operatively. Secondary outcomes were post-operative morphine consumption, side effects and patient satisfaction.
The mean VAS between two groups were comparable up to 8 h. Group E showed significantly reduced VAS compared to Group L at 12 h (2.32 ± 0.59 vs 2.62 ± 0.67, = 0.019) and 24 h (2.30 ± 0.58 vs 2.62 ± 0.57, = 0.006). Group E showed significantly reduced VAS compared to Group L at 5 min and from 4 to 24 h. Total morphine consumption, side effects and patient satisfaction were comparable.
We conclude that CEI is a superior analgesic technique compared to CWI in total abdominal hysterectomy in terms of reduced pain scores.
持续伤口浸润（CWI）正逐渐成为持续硬膜外输注（CEI）的替代方法。本研究比较了全腹子宫切除术（TAH）患者中CEI与CWI的术后疼痛评分。
这项前瞻性随机对照试验纳入了102例计划行TAH的患者，将其随机分为E组（CEI）或L组（CWI）。E组在诱导前插入导管（硬膜外/伤口浸润），L组在手术结束时插入。根据标准方案实施全身麻醉。手术结束时，两组均接受10 mL的0.2%罗哌卡因推注，随后通过各自的导管以6 mL/h的速度输注。他们还接受了吗啡静脉自控镇痛。主要结局是术后静息时的视觉模拟评分（VAS）和深呼吸时的VAS。次要结局是术后吗啡用量、副作用和患者满意度。
两组之间的平均VAS在8小时内相当。E组在12小时（2.32±0.59 vs 2.62±0.67，P = 0.019）和24小时（2.30±0.58 vs 2.62±0.57，P = 0.006）时的VAS显著低于L组。E组在5分钟时以及4至24小时时的VAS显著低于L组。吗啡总用量、副作用和患者满意度相当。
我们得出结论，在全腹子宫切除术中，就降低疼痛评分而言，CEI是一种优于CWI的镇痛技术。
