Van Ee R, Hemrika D J, De Blok S, Van Der Linden C, Lip H
Department of Anaesthesiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
Obstet Gynecol. 1996 Oct;88(4 Pt 1):568-72. doi: 10.1016/0029-7844(96)00222-0.
To determine whether preoperative ketoprofen and mesosalpinx infiltration, either alone or in combination, favorably influence postoperative recovery after outpatient laparoscopic sterilization.
In a double-blind, randomized, placebo-controlled study, 20 women received 100 mg of oral ketoprofen preoperatively, and each mesosalpinx was infiltrated with 5 mL of saline plus epinephrine 1:200,000; 20 women were given oral ketoprofen, and each mesosalpinx was infiltrated with 5 mL of bupivacaine 0.5% with epinephrine 1:200,000; and 20 women received a placebo capsule with mesosalpinx infiltration. Pain was assessed by a visual analogue scale and a self-assessment 11-point scale; outcome was assessed by discharge time, consumption of analgesics, incidence of nausea and vomiting, and the number of postoperative days to full recovery.
Pain ratings in the ketoprofen-only group were significantly higher than in the two other groups (P < .001). Preoperative ketoprofen alone provided insufficient postoperative pain relief, necessitating the use of opiates and peripheral analgesics. Nausea and vomiting were highest in these subjects, as was intake of peripheral analgesics at home. Times to discharge were also the longest in this group (median 385 minutes, range 260-510) and differed significantly from both other groups (P < .001). It took 4-13 days to recover. In contrast, women with only a mesosalpinx block ambulated and recovered sooner, but times to discharge were still prolonged (median 240 minutes, range 105-375). Recovery usually occurred by the fourth postoperative day. The combination of preoperative ketoprofen and mesosalpinx block resulted in the shortest times to discharge (median 190 minutes, range 80-330), the least consumption of peripheral analgesics, and the lowest incidence of nausea and vomiting. Recovery occurred by the fourth postoperative day.
Mesosalpinx infiltration has a favorable effect on postoperative recovery after day-surgery laparoscopic sterilization. Still better results can be obtained with a multimodal analgesic approach, combining mesosalpinx infiltration with preoperative ketoprofen.
确定术前单独使用酮洛芬、输卵管系膜浸润，或两者联合使用，是否对门诊腹腔镜绝育术后的恢复有积极影响。
在一项双盲、随机、安慰剂对照研究中，20名女性术前口服100毫克酮洛芬，每侧输卵管系膜用5毫升生理盐水加1:200,000肾上腺素浸润；20名女性口服酮洛芬，每侧输卵管系膜用5毫升含1:200,000肾上腺素的0.5%布比卡因浸润；20名女性接受安慰剂胶囊并进行输卵管系膜浸润。通过视觉模拟量表和11点自我评估量表评估疼痛；通过出院时间、镇痛药消耗量、恶心和呕吐发生率以及术后完全恢复天数评估结果。
仅使用酮洛芬组的疼痛评分显著高于其他两组（P <.001）。单独术前使用酮洛芬术后镇痛效果不足，需要使用阿片类药物和外周镇痛药。这些受试者的恶心和呕吐发生率最高，在家中外周镇痛药的摄入量也最高。该组出院时间也最长（中位数385分钟，范围260 - 510），与其他两组有显著差异（P <.001）。恢复需要4 - 13天。相比之下，仅进行输卵管系膜阻滞的女性活动和恢复更快，但出院时间仍延长（中位数240分钟，范围105 - 375）。通常在术后第四天恢复。术前酮洛芬和输卵管系膜阻滞联合使用导致出院时间最短（中位数190分钟，范围80 - 330），外周镇痛药消耗量最少，恶心和呕吐发生率最低。在术后第四天恢复。
输卵管系膜浸润对日间手术腹腔镜绝育术后的恢复有积极影响。将输卵管系膜浸润与术前酮洛芬联合使用的多模式镇痛方法可取得更好的效果。
