Division of Female Pelvic Medicine and Reconstructive Surgery, Atlantic Health System, Morristown, New Jersey (Drs. Iwanoff and Salamon).
Division of Female Pelvic Medicine and Reconstructive Surgery, Madigan Army Medical Center, Joint Base Lewis-McChord, Washington (Dr. Iwanoff).
J Minim Invasive Gynecol. 2019 Sep-Oct;26(6):1133-1138. doi: 10.1016/j.jmig.2018.11.005. Epub 2018 Nov 22.
To study the effects of liposomal bupivacaine (LB) compared with bupivacaine hydrochloride with lidocaine on postoperative day 1 pain scores.
A randomized controlled trial (Canadian Task Force classification 1).
An academic medical center within the department of female pelvic medicine and reconstructive surgery.
Fifty-seven patients undergoing midurethral sling placement by a fellowship-trained urogynecologic surgeon and a fellow in female pelvic medicine and reconstructive surgery.
Fifty-seven patients were enrolled to participate in this study. There were 24 patients randomized to receive liposomal bupivacaine and 33 to receive a mixture of bupivacaine and lidocaine during the placement of a retropubic midurethral sling.
Patients were given a diary of pain scales and asked to record their level of pain using the provided visual analog scale scored on a 100-mm Likert scale. Patients recorded their pain 4 hours after hospital discharge and on the night of surgery and their most intense pain each day thereafter for 7 days postoperatively. In addition, patients recorded total opioid and nonsteroidal anti-inflammatory drug consumption daily for 1 week postoperatively. Finally, the quality of recovery was assessed using the Quality of Recovery-15 (QoR-15) questionnaire scores. The median pain score in the experimental group was 20 mm (range, 0-80 mm) versus 30 mm (range, 0-60 mm) in the comparative group (p = .046). The postoperative day 1 QoR-15 scores were significantly lower in the LB group (124 [range, 54-150] vs 144 [range, 68-150], p = .007). There were no significant differences in opioid and nonsteroidal anti-inflammatory drug consumption, the remaining pain scores, or postoperative day 7 QoR-15 scores.
The results suggest the use of liposomal bupivacaine during retropubic midurethral sling placement does not provide a clinically significant difference in postoperative day 1 pain scores when compared with immediate-acting bupivacaine hydrochloride and lidocaine.
研究与布比卡因盐酸盐加利多卡因相比，包载布比卡因（LB）对术后第 1 天疼痛评分的影响。
一项随机对照试验（加拿大卫生保健适宜技术研究所分类 1 级）。
女性盆底医学与重建外科系的一家学术医疗中心。
由一名妇科泌尿学医师和一名女性盆底医学与重建外科医师施行经耻骨后中段尿道吊带置入术的 57 例患者。
57 例患者被纳入本研究。其中 24 例患者接受 LB 治疗，33 例患者接受布比卡因盐酸盐加利多卡因治疗。
患者被提供疼痛评分日记，并要求使用提供的 100-mm 线性评分量表来记录他们的疼痛程度。患者在出院后 4 小时、手术当晚以及术后第 7 天的每天最剧烈疼痛时记录疼痛程度。此外，患者在术后 1 周内每天记录阿片类药物和非甾体类抗炎药的总消耗量。最后，使用恢复质量问卷（QoR-15）评分评估恢复质量。实验组的中位数疼痛评分 20 mm（范围，0-80 mm），而对照组为 30 mm（范围，0-60 mm）（p=0.046）。LB 组术后第 1 天 QoR-15 评分明显较低（124[范围，54-150]vs 144[范围，68-150]，p=0.007）。阿片类药物和非甾体类抗炎药消耗、其余疼痛评分或术后第 7 天 QoR-15 评分均无显著差异。
结果表明，与即刻起效的布比卡因盐酸盐加利多卡因相比，在耻骨后中段尿道吊带置入术中使用 LB 并不能显著降低术后第 1 天的疼痛评分。
