Department of Surgery, Tehran University of Medical Sciences, Tehran, Iran.
Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Langenbecks Arch Surg. 2022 Nov;407(7):2853-2859. doi: 10.1007/s00423-022-02645-y. Epub 2022 Aug 8.
The efficacy of intraperitoneal (IP) and incisional use of local anesthesia in laparoscopic cholecystectomy is a promising subject regarding post-operative pain control. In this study, we aim to compare these methods using lidocaine as the local anesthetic.
This study was a double-blinded randomized controlled trial. Eighty-two patients, candidates for laparoscopic cholecystectomy, were included. Participants were randomly divided into two equal groups; the instillation group and the infiltration group. In the instillation group, a 2% lidocaine ampule was instilled in the gallbladder bed after removal of the gallbladder. In the infiltration group, a 2% lidocaine ampule was injected subcutaneously into the port sites before making the incisions for the insertion of laparoscopic ports.
The mean age of patients were 41.66 ± 14.44 and 48.05 ± 17.03 years in the instillation and infiltration groups, respectively. The etiologies recorded in this study were: acute calculous cholecystitis (29.3%), symptomatic gallstone (68.3%), and polyp (2.4). The pain severity, evaluated at six different times, from immediately after awakening from anesthesia to 24 h after the operation, was not significantly different between the two groups (p-value = 0.329). Consumption of nonsteroidal anti-inflammatory drugs and narcotics, were statistically lower in the instillation group (p-value = 0.013 and 0.003, respectively). However, hospitalization period, time spent to return to normal bowel movements and oral diet, and postoperative nausea/vomiting were not significantly significant between the groups.
IP instillation of lidocaine following laparoscopic cholecystectomy offers post-operative pain relief and is associated with lower analgesic consumption in comparison to subcutaneous injection of this agent at the port site.
局部麻醉在腹腔镜胆囊切除术（LC）中的腹腔内（IP）和切口使用在术后疼痛控制方面是一个很有前途的课题。在这项研究中，我们旨在使用利多卡因作为局部麻醉剂来比较这些方法。
这是一项双盲随机对照试验。共纳入 82 例接受腹腔镜胆囊切除术的患者。参与者被随机分为两组，即灌洗组和浸润组。在灌洗组中，在取出胆囊后将 2%利多卡因安瓿注入胆囊床。在浸润组中，在插入腹腔镜端口之前，将 2%利多卡因安瓿皮下注射到端口部位。
两组患者的平均年龄分别为 41.66±14.44 岁和 48.05±17.03 岁。本研究记录的病因有：急性结石性胆囊炎（29.3%）、症状性胆囊结石（68.3%）和息肉（2.4%）。在术后 6 个不同时间点（从麻醉苏醒后即刻到术后 24 小时）评估的疼痛严重程度，两组之间无显著差异（p 值=0.329）。浸润组非甾体抗炎药和麻醉性镇痛药的消耗明显低于灌洗组（p 值分别为 0.013 和 0.003）。然而，两组间的住院时间、恢复正常肠蠕动和口服饮食的时间以及术后恶心/呕吐无显著差异。
与在端口部位皮下注射利多卡因相比，LC 后腹腔内灌洗利多卡因可减轻术后疼痛，并与较低的镇痛药物消耗相关。
