Ali P B, Cotton B R, Williamson K M, Smith G
Department of Anaesthesia, Leicester Royal Infirmary.
Br J Anaesth. 1998 Feb;80(2):245-7. doi: 10.1093/bja/80.2.245.
We have compared pain scores at rest and on standardized movement, and morphine consumption using patient-controlled analgesia in 60 patients who had undergone total abdominal hysterectomy. Patients were allocated randomly to one of three groups: in the saline group, 0.9% sodium chloride 50 ml was administered into the pelvic cavity before closure of the peritoneum; in the second group, the solution administered was 20 ml of 0.5% bupivacaine solution with epinephrine 1:200,000 diluted with saline to a final volume of 50 ml; in the third group, the solution used was 20 ml [corrected] of 2% lidocaine with epinephrine 1:200,000 diluted with saline to a final volume of 50 ml. We found that there was no significant difference between the three groups in visual analogue pain scores at 8, 12, 36 or 48 h after operation at rest or on movement, and no significant difference in sedation or dose of antiemetic administered. Mean morphine consumption in the first 24 h was 54.6 (SEM 5.9) mg in the saline group, 55.5 (6.4) mg in the bupivacaine group and 52.5 (5.3) mg in the lidocaine group. In the second 24 h, morphine consumption was 34.9 (6.6) mg, 28.1 (3.5) mg and 28.0 (3.5) mg in the three groups, respectively. We conclude that i.p. administration of local anaesthetic solution into the pelvic cavity did not confer appreciable analgesia in patients undergoing abdominal hysterectomy.
我们比较了60例行全腹子宫切除术患者静息及标准活动时的疼痛评分，以及采用患者自控镇痛时的吗啡消耗量。患者被随机分为三组：生理盐水组，在关闭腹膜前向盆腔内注入50 ml 0.9%氯化钠溶液；第二组，注入的溶液为20 ml 0.5%布比卡因溶液加1:200,000肾上腺素，用生理盐水稀释至最终体积50 ml；第三组，使用的溶液为20 ml[校正后]2%利多卡因加1:200,000肾上腺素，用生理盐水稀释至最终体积50 ml。我们发现，三组患者术后8、12、36或48小时静息或活动时的视觉模拟疼痛评分无显著差异，镇静及使用的止吐药剂量也无显著差异。生理盐水组前24小时吗啡平均消耗量为54.6（标准误5.9）mg，布比卡因组为55.5（6.4）mg，利多卡因组为52.5（5.3）mg。在第二个24小时，三组的吗啡消耗量分别为34.9（6.6）mg、28.1（3.5）mg和28.0（3.5）mg。我们得出结论，对行腹部子宫切除术的患者经腹腔向盆腔内注射局部麻醉溶液并不能带来明显的镇痛效果。
