Mishra Smarika, Gogia Pratiksha, Yadav Sandeep, Kumar Sumit, Singh Prachi, Malviya Deepak
Department of Anesthesia and Critical Care, Dr. RMLIMS, Lucknow, Uttar Pradesh, India.
Department of Anesthesia and Critical Care, Teerthanker Mahaveer Medical College & Research Centre, Moradabad, Uttar Pradesh, India.
Anesth Essays Res. 2021 Jul-Sep;15(3):332-337. doi: 10.4103/aer.aer_104_21. Epub 2022 Feb 14.
Hysterectomy, probably the most common non-pregnancy related surgery performed in gynaecology, is associated with moderate to severe post-operative pain. Wound infiltration with local anaesthetic agent reduces the transmission of pain from the wound, in addition, local inflammatory response to the injury is also suppressed. The infiltration of local anaesthesia can be done either pre- or post-operatively. The present study was designed to determine the efficacy of pre-incisional infiltration versus post-incisional infiltration with 0.25% Bupivacaine in providing post-operative pain relief in patients undergoing abdominal hysterectomy.
In Prospective Interventional Randomised study, 90 female patients posted for elective abdominal hysterectomy under general anaesthesia were randomly allocated into three equal groups of 30 patients each.
Patients receiving subcutaneous infiltration with 40 mL of 0.25% Bupivacaine 5 mins before skin incision.
Patients receiving subcutaneous infiltration of surgical area with 40 mL of 0.25% Bupivacaine at end of surgery (after peritoneal closure).
Patients receiving no local anaesthetic infiltration. Observations were made for the duration of effective analgesia from end of the surgery until the first use of rescue analgesic along with the frequency and cumulative amount of rescue analgesics in 24 hours.
We found that at baseline, pain score of patients in Group III (3.87±1.17) was maximum followed by that in Group I (2.57±0.90) and minimum in Group II (2.20±0.61). Requirement of first analgesia was earliest in Group III (79.50±23.90 minutes) followed by Group I (136.83±13.16 minutes) and last in Group II (146.17±12.78 minutes), in addition, cumulative dose of analgesia was required by patients in Group III (152.50±36.76 mg) followed by that in Group I (132.50±37.80 mg) and minimum by that in Group II (115.00±38.06 mg).
Subcutaneous infiltration of Bupivacaine either pre-incisional or post-incisional, helped to reduce the immediate post-operative pain intensity, delayed the first rescue analgesic requirement, reduced the post-operative dose and frequency of rescue analgesia. However, post-incisional intervention had an edge over pre-incisional intervention.
子宫切除术可能是妇科最常见的非妊娠相关手术，与中度至重度术后疼痛相关。用局部麻醉剂进行伤口浸润可减少伤口疼痛的传导，此外，还能抑制对损伤的局部炎症反应。局部麻醉浸润可在术前或术后进行。本研究旨在确定在接受腹部子宫切除术的患者中，术前切口浸润与术后切口浸润0.25%布比卡因在提供术后疼痛缓解方面的疗效。
在一项前瞻性干预随机研究中，90例计划在全身麻醉下进行择期腹部子宫切除术的女性患者被随机分为三组，每组30例。
在皮肤切口前5分钟接受40毫升0.25%布比卡因皮下浸润的患者。
在手术结束时（腹膜关闭后）接受40毫升0.25%布比卡因手术区域皮下浸润的患者。
第三组（对照组）：未接受局部麻醉浸润的患者。观察从手术结束到首次使用急救镇痛药的有效镇痛持续时间，以及24小时内急救镇痛药的使用频率和累积用量。
我们发现，在基线时，第三组患者的疼痛评分（3.87±1.17）最高，其次是第一组（2.57±0.90），第二组最低（2.20±0.61）。首次镇痛的需求在第三组最早（79.50±23.90分钟），其次是第一组（136.83±13.16分钟），最后是第二组（146.17±12.78分钟）。此外，第三组患者所需的镇痛累积剂量（152.50±36.76毫克），其次是第一组（132.50±37.80毫克），第二组最低（115.00±38.06毫克）。
术前或术后切口浸润布比卡因有助于降低术后即刻疼痛强度，延迟首次急救镇痛需求，减少术后急救镇痛的剂量和频率。然而，术后切口干预比术前切口干预更具优势。
