Pasqualucci A, de Angelis V, Contardo R, Colò F, Terrosu G, Donini A, Pasetto A, Bresadola F
Department of Anesthesiology and Intensive Care, University of Udine, Italy.
Anesthesiology. 1996 Jul;85(1):11-20. doi: 10.1097/00000542-199607000-00003.
A controversy exists over the effectiveness and clinical value of preemptive analgesia. Additional studies are needed to define the optimum intensity, duration, and timing of analgesia relative to incision and surgery.
One hundred twenty patients undergoing laparoscopic cholecystectomy under general anesthesia plus topical peritoneal local anesthetic or saline were studied. Local anesthetic (0.5% bupivacaine with epinephrine) or placebo solutions were given as follows: immediately after the creation of a pneumoperitoneum (blocking before surgery), and at the end of the operation (blocking after surgery). Patients were randomly assigned to one of four groups of 30 patients each. Group A (placebo) received 20 ml 0.9% saline both before and after surgery, group B received 20 ml 0.9% saline before surgery and 20 ml local anesthetic after surgery, group C received 20 ml local anesthetic both before and after surgery, group P received 20 ml local anesthetic before and 20 ml 0.9% saline after surgery. Pain was assessed using a visual analog scale and a verbal rating scale at 0, 4, 8, 12, and 24 h after surgery. Metabolic endocrine responses (blood glucose and cortisol concentrations) and analgesic requirements also were investigated.
Pain intensity (visual analog and verbal rating scales) and analgesic requirements were significantly less in the group receiving bupivacaine after surgery compared to placebo. However, in the groups receiving bupivacaine before surgery, both pain intensity and analgesic consumption were less than in the group receiving bupivacaine only after surgery. Blood glucose and cortisol concentrations 3 h after surgery were significantly less in groups receiving bupivacaine before surgery.
The results indicate that intraperitoneal local anesthetic blockade administered before or after surgery preempts postoperative pain relative to an untreated placebo-control condition. However, the timing of administration is also important in that postoperative pain intensity and analgesic consumption are both lower among patients treated with local anesthetic before versus after surgery.
超前镇痛的有效性和临床价值存在争议。需要更多研究来确定相对于切口和手术的最佳镇痛强度、持续时间和时机。
对120例接受全身麻醉加局部腹膜局部麻醉或生理盐水的腹腔镜胆囊切除术患者进行研究。局部麻醉药（0.5%布比卡因加肾上腺素）或安慰剂溶液给药如下：气腹建立后立即（术前阻滞），以及手术结束时（术后阻滞）。患者被随机分为四组，每组30例。A组（安慰剂组）在手术前后均接受20 ml 0.9%生理盐水，B组在手术前接受20 ml 0.9%生理盐水，手术后接受20 ml局部麻醉药，C组在手术前后均接受20 ml局部麻醉药，P组在手术前接受20 ml局部麻醉药，术后接受20 ml 0.9%生理盐水。术后0、4、8、12和24小时使用视觉模拟量表和语言评定量表评估疼痛。还研究了代谢内分泌反应（血糖和皮质醇浓度）和镇痛需求。
与安慰剂相比，术后接受布比卡因的组疼痛强度（视觉模拟和语言评定量表）和镇痛需求明显更低。然而，术前接受布比卡因的组，疼痛强度和镇痛药物消耗量均低于仅在术后接受布比卡因的组。术前接受布比卡因的组术后3小时血糖和皮质醇浓度明显更低。
结果表明，相对于未治疗的安慰剂对照情况，手术前后给予腹腔内局部麻醉阻滞可预防术后疼痛。然而，给药时机也很重要，因为术前接受局部麻醉药治疗的患者术后疼痛强度和镇痛药物消耗量均低于术后接受治疗的患者。
