Rahimzadeh Poupak, Faiz Seyed Hamid Reza, Hoseini Mostafa, Mousavie Seyed Hamzeh, Imani Farnad, Negah Ali Reza
Pain Research Center, Iran University of Medical Sciences, Tehran, Iran.
Rasool Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
Med J Islam Repub Iran. 2018 Nov 13;32:112. doi: 10.14196/mjiri.32.112. eCollection 2018.
Given the importance of patients' pain after laparoscopic surgeries, this study was conducted to compare the effectiveness of intraperitoneal bupivacaine, acetazolamide, and placebo on pain relief after laparoscopic cholecystectomy surgery. Patients admitted to Rasool Akram hospital with physical status I or II, based on the American Society of Anesthesiologists (ASA) system, who were candidates for laparoscopic cholecystectomy surgery due to gallstones, were included in this study. Patients were divided into 3 groups (each group containing 20 patients) using block randomization with foursome blocks. Group 1 received bupivacaine, group 2 acetazolamide, and group 3 intravenous saline as placebo. After surgery, pain score was assessed by visual analogue scale, and shoulder pain and analgesic doses were also measured. The mentioned parameters were assessed at 1, 4, 8, 12, and 24 hours after surgery. In this study, 60 patients were included in 3 groups. The mean pain recorded (VAS) at 1, 4, and 8 hours after surgery was not significantly different between acetazolamide and bupivacaine groups, but their score was significantly lower than the placebo group (p<0.05). However, the score recorded at 12 and 24 hours after surgery was not significantly different between the 3 groups (p>0.05). Mean of pain reliever (acetaminophen) injected to the patients when needed was not significantly different among the 3 intervention groups (p<0.05). The highest prevalence of shoulder pain (70%) belonged to the placebo group and the lowest (25%) to acetazolamide (p<0.05). Mean heart rate, systolic blood pressure, diastolic blood pressure, and the respiratory rate were not significantly different among intervention groups in 1, 4, 8, 12, and 24 hours after surgery (p>0.05). According to the results, acetazolamide and bupivacaine injection reduced pain in early hours after laparoscopy. However, pain intensity was not different between intervention groups and the control group after 12 hours, so re-prescription seems to be appropriate at this time. Acetazolamide injection significantly reduces shoulder pains after surgery.
鉴于腹腔镜手术后患者疼痛的重要性，本研究旨在比较腹腔内注射布比卡因、乙酰唑胺和安慰剂对腹腔镜胆囊切除术后疼痛缓解的效果。根据美国麻醉医师协会（ASA）系统，身体状况为I或II级、因胆结石而适合进行腹腔镜胆囊切除术的患者被纳入拉苏勒·阿克拉姆医院的本研究。患者使用四人一组的区组随机化方法分为3组（每组20例患者）。第1组接受布比卡因，第2组接受乙酰唑胺，第3组接受静脉注射生理盐水作为安慰剂。术后，通过视觉模拟量表评估疼痛评分，并测量肩部疼痛和镇痛剂量。上述参数在术后1、4、8、12和24小时进行评估。本研究中，3组共纳入60例患者。术后1、4和8小时记录的平均疼痛（视觉模拟量表）在乙酰唑胺组和布比卡因组之间无显著差异，但它们的评分显著低于安慰剂组（p<0.05）。然而，术后12和24小时记录的评分在3组之间无显著差异（p>0.05）。3个干预组按需注射给患者的止痛剂（对乙酰氨基酚）的平均值无显著差异（p<0.05）。肩部疼痛的最高发生率（70%）属于安慰剂组，最低发生率（25%）属于乙酰唑胺组（p<0.05）。术后1、4、8、12和24小时，干预组之间的平均心率、收缩压、舒张压和呼吸频率无显著差异（p>0.05）。根据结果，乙酰唑胺和布比卡因注射在腹腔镜检查后的早期可减轻疼痛。然而，12小时后干预组和对照组之间的疼痛强度无差异，因此此时重新开药似乎是合适的。乙酰唑胺注射可显著减轻术后肩部疼痛。
