局部麻醉浸润对腹腔镜胆囊切除术术后疼痛的影响：随机临床试验。

Effect of local anaesthetic infiltration on postoperative pain after laparoscopic cholecystectomy: randomized clinical trial.

机构信息

Department of Surgery, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Department of Anesthesiology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

出版信息

BJS Open. 2022 May 2;6(3). doi: 10.1093/bjsopen/zrac066.

BACKGROUND

Local anaesthetic infiltration is widely used to reduce pain after laparoscopic cholecystectomy (LC). This trial evaluated the effect of depth of local anaesthetic infiltration on postoperative pain reduction after LC.

METHODS

Patients undergoing elective LC between March 2018 and February 2019 were randomized into no infiltration, subcutaneous infiltration, and rectus sheath infiltration using bupivacaine. The primary outcome was 24-h postoperative cumulative morphine use, and the secondary outcomes were mean 24-h Numerical Rating Scale (NRS) for pain, and nausea, and vomiting. Subgroups were compared and multivariable analyses were performed.

RESULTS

Out of 170 eligible patients, 162 were selected and 150 patients were analysed: 48 in the no-infiltration group, 50 in the subcutaneous infiltration group, and 52 in the rectus sheath infiltration group. The groups had similar clinical features, although mean BMI was higher in the subcutaneous infiltration group (P = 0.001). The 24-h cumulative morphine use in the rectus sheath infiltration group was significantly lower than in the no-infiltration group (P = 0.043), but no difference was observed between the subcutaneous infiltration and no-infiltration groups (P = 0.999). One hour after surgery, the rectus sheath infiltration group had a significantly lower NRS score than the no-infiltration and subcutaneous infiltration groups respectively (P = 0.006 and P = 0.031); however, the score did not differ among the three groups at any of the time points from 2 h after the surgery. The incidence of nausea or vomiting was comparable among the three groups. Multivariable analysis documented that a lower dose of morphine use was associated with rectus sheath infiltration (P = 0.004) and diabetes (P = 0.001); whereas, increased morphine use was associate with age (P = 0.040) and a longer duration of surgery (P = 0.007).

CONCLUSIONS

Local anaesthetic infiltration into the rectus sheath reduced postoperative cumulative morphine use and the immediate NRS score in patients undergoing LC; however, the pain scores were comparable 2 h after surgery.

REGISTRATION NUMBER

TCTR20201103002 (http://www.thaiclinicaltrials.org).

背景

局部麻醉浸润广泛用于减轻腹腔镜胆囊切除术（LC）后的疼痛。本试验评估了局部麻醉浸润深度对 LC 术后疼痛减轻的影响。

方法

2018 年 3 月至 2019 年 2 月期间，选择接受择期 LC 的患者，随机分为不浸润、皮下浸润和布比卡因腹直肌鞘浸润组。主要结局是术后 24 小时累积吗啡用量，次要结局是平均 24 小时数字评分量表（NRS）疼痛评分和恶心呕吐。对亚组进行比较并进行多变量分析。

结果

在 170 名符合条件的患者中，选择了 162 名患者，其中 150 名患者进行了分析：不浸润组 48 例，皮下浸润组 50 例，腹直肌鞘浸润组 52 例。各组临床特征相似，但皮下浸润组平均 BMI 较高（P=0.001）。腹直肌鞘浸润组 24 小时累积吗啡用量明显低于不浸润组（P=0.043），但皮下浸润组与不浸润组无差异（P=0.999）。术后 1 小时，腹直肌鞘浸润组 NRS 评分明显低于不浸润组和皮下浸润组（P=0.006 和 P=0.031）；然而，在术后 2 小时后的任何时间点，三组之间的评分均无差异。三组恶心或呕吐的发生率相似。多变量分析表明，吗啡用量较低与腹直肌鞘浸润（P=0.004）和糖尿病（P=0.001）有关；而吗啡用量增加与年龄（P=0.040）和手术时间延长（P=0.007）有关。