Bradford T H, Robertson K, Norman P F, Meeks G R
Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, USA.
Obstet Gynecol. 1995 May;85(5 Pt 1):687-91. doi: 10.1016/0029-7844(95)00030-u.
To determine whether postoperative pain and nausea after laparoscopic sterilization can be reduced with a combination of bupivacaine, metoclopramide, scopolamine, ketorolac, and gastric suctioning.
Women undergoing outpatient laparoscopic sterilization were randomized to protocol management or nontreatment groups. Each patient received standard general endotracheal anesthesia. Protocol subjects received intramuscular ketorolac 60 mg and scopolamine 0.25 mg, intravenous metoclopramide 10 mg, and gastric suctioning; bupivacaine (2.5 mg/mL) with epinephrine (5 micrograms/mL) was injected at trocar sites and dripped onto the fallopian tubes. The nontreatment group served as controls. Visual analogue scales were used to evaluate pain and nausea (measured in millimeters). Demographic characteristics, postoperative requirements for analgesics and antiemetics, time to discharge, and unscheduled admission were also evaluated.
During a 7-month period, 71 women were enrolled. Protocol subjects (N = 35) reported pain severity of 27.9 +/- 19.1 mm (mean +/- standard deviation), whereas controls (N = 36) reported 59.3 +/- 23.3 mm (P < .001). Fourteen protocol patients requested additional pain medication, compared with 29 controls (P < .001). Protocol patients indicated a nausea severity of 9.9 +/- 18.7 mm, whereas the controls reported 38.8 +/- 35.5 mm (P < .001). Only one protocol patient required nausea medication, compared with nine controls (P < .02). Severity of pain correlated with severity of nausea (r = 0.38166, P < .001). Protocol patients were discharged from the outpatient surgery unit in 148.6 +/- 45.0 minutes, compared with 176.4 +/- 58.5 minutes for controls (P < .03).
This regimen reduced the severity of pain and nausea after outpatient laparoscopic sterilization. The need for additional analgesics and antiemetics was also reduced. Protocol patients were discharged earlier than controls. These benefits seem to accrue without significant risk. We believe that this regimen may also be useful in other ambulatory laparoscopic procedures.
确定布比卡因、甲氧氯普胺、东莨菪碱、酮咯酸和胃抽吸联合使用是否能减轻腹腔镜绝育术后的疼痛和恶心。
将接受门诊腹腔镜绝育术的女性随机分为方案管理组或非治疗组。每位患者均接受标准的全身气管内麻醉。方案组受试者接受肌肉注射酮咯酸60毫克和东莨菪碱0.25毫克、静脉注射甲氧氯普胺10毫克以及胃抽吸；在套管针穿刺部位注射含肾上腺素（5微克/毫升）的布比卡因（2.5毫克/毫升），并滴注到输卵管上。非治疗组作为对照。使用视觉模拟量表评估疼痛和恶心（以毫米为单位测量）。还评估了人口统计学特征、术后对镇痛药和止吐药的需求、出院时间和非计划入院情况。
在7个月的时间里，共纳入71名女性。方案组受试者（N = 35）报告的疼痛严重程度为27.9±19.1毫米（平均值±标准差），而对照组（N = 36）报告为59.3±23.3毫米（P <.001）。14名方案组患者需要额外的止痛药物，而对照组为29名（P <.001）。方案组患者表示恶心严重程度为9.9±18.7毫米，而对照组报告为38.8±35.5毫米（P <.001）。只有1名方案组患者需要使用止吐药物，而对照组为9名（P <.02）。疼痛严重程度与恶心严重程度相关（r = 0.38166，P <.001）。方案组患者在门诊手术单元的出院时间为148.6±45.0分钟，而对照组为176.4±58.5分钟（P <.03）。
该方案减轻了门诊腹腔镜绝育术后的疼痛和恶心严重程度。对额外镇痛药和止吐药的需求也有所减少。方案组患者比对照组更早出院。这些益处似乎在没有显著风险的情况下实现。我们认为该方案可能对其他门诊腹腔镜手术也有用。
