利多卡因加肾上腺素对腹部子宫肌瘤切除术术中出血的安全性和有效性：一项双盲临床试验。

Safety and efficacy of lidocaine plus epinephrine on intraoperative bleeding in abdominal myomectomy: A double-blind clinical trial.

作者信息

Mansour-Ghanaei Mandana, Hosseinzadeh Fatemeh, Sharami Seyedeh Hajar, Biazar Gelareh, Noori Fatemeh, Asgari-Ghalebin Seyed Mohammad

机构信息

Reproductive Health Research Center, Department of Obstetrics & Gynecology, Al-zahra Hospital, School of Medicine Guilan University of Medical Sciences Rasht Iran.

Anesthesiology Research Center, Department of Anesthesiology, Al-zahra hospital Guilan University of Medical Sciences Rasht Iran.

出版信息

Health Sci Rep. 2022 Mar 9;5(2):e551. doi: 10.1002/hsr2.551. eCollection 2022 Mar.

DOI:10.1002/hsr2.551

PMID:35284653

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8905574/

Abstract

BACKGROUND

Uterine fibroid is a common benign pelvic tumor and abdominal myomectomy may cause excessive intraoperative bleeding, which may lead to adverse outcomes.

OBJECTIVE

This study was planned to evaluate the effectiveness of the injection of lidocaine plus epinephrine to reduce intraoperative bleeding in abdominal myomectomy.

METHODS

During October 2019 and May 2020, 60 eligible women with uterine fibroids were enrolled in a randomized controlled trial. Our patients were divided into two groups of lidocaine plus epinephrine defined as Group L and placebo defined as Group P. In group L, lidocaine 3 mg/kg plus 0.5 ml of adrenaline which reached to 50 cc with saline solution and in group P, 50 ml of normal saline was used. Both the combined solution and normal saline were infiltrated to the serous and myometrium above and around the fibroid before incision. Patients' demographic data, total operative time, hemoglobin changes, and the degree of surgical difficulty were evaluated and compared between the two groups.

RESULTS

There was no significant difference between the two groups in terms of demographic data. Hemoglobin changes ( 0.0001) and the degree of surgery difficulty ( = 0.01) were significantly lower in Group L compared with Group P. In each group the drop in hemoglobin levels from baseline to 4 h postoperatively was significant ( 0.0001). A significantly meaningful correlation was reported between hemoglobin changes and the degree of surgery difficulty with the size of the uterine and fibroids (< 0.05). While a negative correlation was found regarding gravidity and surgery difficulty ( = -0.413, = 0.02). Surgery duration was longer in Group P compared with Group L 70.66 ± 19.85 versus 66.16 ± 14.48, respectively, but with no significant difference ( = 0.32). No significant adverse reaction or serious complication was reported in the two groups. Hemodynamic parameters were kept in the normal range throughout the surgery.

CONCLUSION

A combination of lidocaine plus epinephrine during abdominal myomectomy appears to be a safe and effective method in reducing blood loss.

摘要

背景

子宫肌瘤是一种常见的盆腔良性肿瘤，腹部子宫肌瘤切除术可能导致术中出血过多，进而可能导致不良后果。

目的

本研究旨在评估利多卡因加肾上腺素注射在减少腹部子宫肌瘤切除术中出血的有效性。

方法

在2019年10月至2020年5月期间，60例符合条件的子宫肌瘤女性患者被纳入一项随机对照试验。我们的患者被分为两组，利多卡因加肾上腺素组定义为L组，安慰剂组定义为P组。在L组中，3mg/kg利多卡因加0.5ml肾上腺素，用生理盐水配制成50cc，在P组中，使用50ml生理盐水。在切开前，将混合溶液和生理盐水均浸润到肌瘤上方和周围的浆膜层和肌层。评估并比较两组患者的人口统计学数据、总手术时间、血红蛋白变化以及手术难度。

结果

两组在人口统计学数据方面无显著差异。与P组相比，L组的血红蛋白变化（P<0.0001）和手术难度程度（P = 0.01）显著更低。每组中，从基线到术后4小时血红蛋白水平的下降均显著（P<0.0001）。据报道，血红蛋白变化和手术难度程度与子宫和肌瘤大小之间存在显著有意义的相关性（P<0.05）。而在妊娠次数和手术难度方面发现呈负相关（r = -0.413，P = 0.02）。P组的手术持续时间比L组长，分别为70.66±19.85和66.16±14.48，但无显著差异（P = 0.32）。两组均未报告显著的不良反应或严重并发症。整个手术过程中血流动力学参数保持在正常范围内。