Huang Yang Y, Suthananthan Arul E, Hunt Victoria, Hruby Jan, Koek Sharnice, Rowcroft Alistair, Beh Han, Jayasundera Mohan
Department of General Surgery, Armadale-Kelmscott Memorial Hospital, Armadale, Western Australia, Australia.
ANZ J Surg. 2019 Jan;89(1-2):101-105. doi: 10.1111/ans.15049. Epub 2019 Jan 24.
Currently, intraoperative use of local anaesthetic is not routinely given in all laparoscopic appendicectomies. Although its use has been widely studied in laparoscopic hernia repairs, gynaecological laparoscopy and laparoscopic cholecystectomies, there are no published trials of the use of intraperitoneal local anaesthetic during laparoscopic appendicectomy in the Australasian setting. The aim of this study was to determine whether the use of intraperitoneal ropivacaine during laparoscopic appendicectomy will reduce the amount of post-operative opiate analgesia used, abdominal pain, post-operative nausea or vomiting, shoulder tip pain and length of hospital stay.
A randomized double-blinded placebo versus control trial was conducted with patients with clinically diagnosed appendicitis undergoing laparoscopic appendicectomy. Primary outcomes measured were the number of times the patient-controlled analgesia (PCA) button was pressed post-operatively and the average and total amount of fentanyl from PCA consumed during the post-operative period from 0 to 6 h and from 6 to 16 h.
A total of 86 patients with 43 patients in the placebo normal saline group and 43 patients in the treatment ropivacaine group were included in the study. During the immediate post-operative period (0-6 h), there was a statistically significant reduction in the number of times the PCA button was pressed in the ropivacaine group compared to the normal saline group (16 versus 24 times, P = 0.02).
Intraperitoneal ropivacaine has an analgesic effect for patients up to 6 h following emergency laparoscopic appendicectomy.
目前，并非所有腹腔镜阑尾切除术都会常规在术中使用局部麻醉剂。尽管其在腹腔镜疝修补术、妇科腹腔镜手术和腹腔镜胆囊切除术中的应用已得到广泛研究，但在澳大利亚环境下，尚无关于腹腔镜阑尾切除术中使用腹腔内局部麻醉剂的已发表试验。本研究的目的是确定在腹腔镜阑尾切除术中使用腹腔内罗哌卡因是否会减少术后阿片类镇痛药的使用量、腹痛、术后恶心或呕吐、肩痛以及住院时间。
对临床诊断为阑尾炎并接受腹腔镜阑尾切除术的患者进行了一项随机双盲安慰剂对照试验。主要测量的结果是术后患者自控镇痛（PCA）按钮被按下的次数，以及术后0至6小时和6至16小时期间PCA消耗的芬太尼的平均量和总量。
共有86例患者纳入研究，其中安慰剂生理盐水组43例，治疗罗哌卡因组43例。在术后即刻（0至6小时），与生理盐水组相比，罗哌卡因组PCA按钮被按下的次数有统计学显著减少（16次对24次，P = 0.02）。
腹腔内罗哌卡因对急诊腹腔镜阑尾切除术后长达6小时的患者有镇痛作用。
