Reza E, Bhuiyan K, Emon R I, Hossain A, Biplob M H, Kader S, Habib A, Hasan R, Chaudary A K, Rahman T, Hasan S, Nisa A A
Dr Ehsanur Reza, Associate Professor, Department of Surgery, Mymensingh Medical College (MMC), Mymensingh, Bangladesh.
Mymensingh Med J. 2020 Apr;29(2):303-310.
Gall stone disease is one of the most common conditions encountered in general surgical practices in adult population. The gold standard treatment for symptomatic gall stone disease is laparoscopic cholecystectomy. It results in less post-operative pain as compared to open cholecystectomy but post-operative pain may be mild, moderate or even severe in some patients. This Randomized control trail was conducted to In-patient department of Surgery, Mymensingh Medical College & Hospital (MMCH), Mymensingh, Bangladesh from April 2018 to September 2018. It was undertaken to evaluate the analgesic effect of intra-peritoneal tramadol instillation in patients undergoing laparoscopic cholecystectomy. Total 70 patients with symptomatic gallstone disease undergoing laparoscopic cholecystectomy were randomized equally in two groups. Then patients were selected in according to the inclusion and exclusion criteria. In first group (Group A), patients were received intra-peritoneal tramadol 100mg (diluted in 20.0ml distilled water). Sprayed 10.0ml diluted tramadol into the sub diaphragmatic area, 5.0ml into the area of gall bladder bed and 5.0ml into the space between the liver and kidney under direct vision just before removal of trocars. In second group (Group B) the conventional operative procedure was followed. Postoperatively, patient was extubated and shifted to recovery room. Data recorded and analyzed, such as post-operative pain score at 1, 4, 8, and 24 hour; cumulative 1, 8 and 24 hour analgesic consumption. In addition that postoperative hospital period monitoring of heart rate, blood pressure, respiratory rate, temperature at 0, 4, 8, 24 hours was also analyzed. Intensity of pain was assessed by Visual Analogue Scale (VAS) scoring system. Patients showed a VAS ≥3 or patients who requested for analgesia was administrated a supplemental dose of analgesic. In the present study the mean pain scores in Group A were found to be low at1hourpost-operative was 0.60±0.56 and there was a gradual increase in score in respect of time interval with peak of 2.07±0.91 at 24 hours. Whereas, in Group B the mean pain scores immediate post-operative period were at its peak was, 2.50±0.82 which decreased to 1.30±0.84 at 1 hour and further there was rise at 4 hours (2.10±0.71) and 24 hours (2.33±0.0.71). But at any point of time the mean VAS remained significantly low (p<0.050) in patients with Group A compared to Group B except at 1st 24 hours (p=0.210). Intra-peritoneal instillation of tramadol for postoperative pain control in laparoscopic cholecystectomy has beneficial effect in terms of postoperative pain relief following laparoscopic cholecystectomy.
胆结石疾病是成人普通外科手术中最常见的病症之一。有症状胆结石疾病的金标准治疗方法是腹腔镜胆囊切除术。与开腹胆囊切除术相比，它导致的术后疼痛更少，但在一些患者中，术后疼痛可能是轻度、中度甚至重度。这项随机对照试验于2018年4月至2018年9月在孟加拉国迈门辛市迈门辛医学院和医院（MMCH）的外科住院部进行。其目的是评估腹腔内注射曲马多对接受腹腔镜胆囊切除术患者的镇痛效果。共有70例有症状胆结石疾病且接受腹腔镜胆囊切除术的患者被平均随机分为两组。然后根据纳入和排除标准选择患者。在第一组（A组），患者接受腹腔内注射100mg曲马多（用20.0ml蒸馏水稀释）。在拔出套管针前，在直视下将10.0ml稀释的曲马多喷入膈下区域，5.0ml喷入胆囊床区域，5.0ml喷入肝肾间隙。在第二组（B组），采用传统手术方法。术后，患者拔管并转入恢复室。记录并分析数据，如术后1、4、8和24小时的疼痛评分；1、8和24小时的累计镇痛药物消耗量。此外，还分析了术后住院期间0、4、8、24小时的心率、血压、呼吸频率、体温监测情况。疼痛强度通过视觉模拟评分法（VAS）评分系统进行评估。VAS评分≥3分的患者或要求使用镇痛剂的患者给予补充剂量的镇痛剂。在本研究中，发现A组术后1小时的平均疼痛评分为0.60±0.56，随着时间间隔评分逐渐增加，24小时时达到峰值2.07±0.91。而在B组，术后即刻平均疼痛评分最高，为2.50±0.82，1小时时降至1.30±0.84，4小时（2.10±0.71）和24小时（2.33±0.71）时又有所上升。但在任何时间点，A组患者的平均VAS评分与B组相比均显著较低（p<0.050），除了第24小时（p=0.210）。腹腔镜胆囊切除术后腹腔内注射曲马多用于术后疼痛控制在减轻术后疼痛方面具有有益效果。
