Department of Anesthesiology and Pain Medicine and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, South Korea.
Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea.
Int J Surg. 2022 Aug;104:106763. doi: 10.1016/j.ijsu.2022.106763. Epub 2022 Jul 6.
Laparoscopic cholecystectomy (LC) causes moderate pain. Various operative analgesic techniques and pharmacologic treatments can reduce postoperative pain. This single-center, single-surgeon randomized controlled study aimed to assess the efficacy of combined operative analgesic techniques and pharmacologic analgesia in decreasing pain in patients undergoing LC.
Fifty-nine patients scheduled for LC were assigned into two groups. In the pharmacologic analgesia (P) group (n = 29), patients were treated with pharmacologic intervention, including preoperative celecoxib (200 mg), intraoperative acetaminophen (1 g), and dexamethasone (8 mg). In the operative analgesic treatments with pharmacologic analgesia (OP) group (n = 30), patients were treated with both operative analgesic techniques and pharmacologic analgesia, including low-pressure pneumoperitoneum, intraperitoneal normal saline irrigation, and aspiration of intraperitoneal carbon dioxide. The area under the curve (AUC) of pain score for postoperative 24 h was assessed at 0, 2, 6, and 24 h post-operation. The analgesic requirements and sleep quality at postoperative day 1 were assessed.
The AUC/24 h of pain scores at rest and on cough were lower in the OP group (p < 0.001 and p = 0.001, respectively). The pain scores at rest were lower in the OP group at postoperative 2, 6, and 24 h (p = 0.001, p = 0.001, and p = 0.048, respectively). The pain scores on cough were lower in the OP group at postoperative 2 and 6 h (p = 0.004 and p = 0.008, respectively). Analgesic requirements were comparable. The sleep quality score at postoperative day 1 was higher in the OP group (56 ± 18 vs. 67 ± 15, absolute difference, 10; 95% confidence interval, 2 to 19; p = 0.017).
Combined operative analgesic therapies and pharmacologic analgesia compared to pharmacologic analgesia alone decreased pain scores and increased sleep quality in patients undergoing LC.
腹腔镜胆囊切除术（LC）会引起中度疼痛。各种手术镇痛技术和药物治疗都可以减轻术后疼痛。本单中心、单外科医生随机对照研究旨在评估联合手术镇痛技术和药物镇痛在减轻行 LC 患者疼痛方面的疗效。
59 例拟行 LC 的患者被分为两组。在药物镇痛（P）组（n=29）中，患者接受药物干预，包括术前塞来昔布（200mg）、术中对乙酰氨基酚（1g）和地塞米松（8mg）。在手术镇痛联合药物镇痛（OP）组（n=30）中，患者接受了手术镇痛技术和药物镇痛，包括低压气腹、腹腔生理盐水冲洗和腹腔二氧化碳抽吸。评估术后 24 小时内疼痛评分的曲线下面积（AUC），在术后 0、2、6 和 24 小时评估。评估术后第 1 天的镇痛需求和睡眠质量。
OP 组的术后 24 小时静息和咳嗽时疼痛评分 AUC 较低（p<0.001 和 p=0.001）。OP 组术后 2、6 和 24 小时静息时疼痛评分较低（p=0.001、p=0.001 和 p=0.048）。OP 组术后 2 和 6 小时咳嗽时疼痛评分较低（p=0.004 和 p=0.008）。镇痛需求相当。OP 组术后第 1 天的睡眠质量评分较高（56±18 比 67±15，绝对差异，10；95%置信区间，2 至 19；p=0.017）。
与单独药物镇痛相比，联合手术镇痛治疗和药物镇痛可降低行 LC 患者的疼痛评分，提高睡眠质量。
