Tsimoyiannis E C, Siakas P, Tassis A, Lekkas E T, Tzourou H, Kambili M
Department of Surgery, G. Hatzikosta General Hospital, Ioannina, Greece.
World J Surg. 1998 Aug;22(8):824-8. doi: 10.1007/s002689900477.
After laparoscopic surgery carbon dioxide remains within the peritoneal cavity for a few days, commonly causing pain. This prospective randomized study was performed to determine the efficacy of intraperitoneal infusion of normal saline on postoperative pain after laparoscopic cholecystectomy. Altogether 300 patients were randomly assigned to one of five groups of 60 patients each. Group A: control group, no peritoneal infusion, no subhepatic drain. Group B: no peritoneal infusion but a subhepatic closed brain was left for 24 hours. Group C: normal saline 25 to 30 ml/kg body weight at a temperature of 37 degrees C was infused under the right hemidiaphragm and left in the peritoneal cavity. Group D: normal saline in a room temperature was infused under the right hemidiaphragm and suctioned after the pneumoperitoneum was deflated. Group E: normal saline was infused and suctioned as in group D, but a subhepatic closed drain was left for 24 hours. Postoperatively, analgesic medication usage, nausea, vomiting, and pain scores were determined at 2, 6, 12, 24, 48, and 72 hours (during hospitalization and at home). Postoperative pain was reduced significantly (p < 0.001) in the patients of groups C, D, and E versus controls, whereas no difference was observed between groups A and B. Among groups C < D and E, group E (p < 0.01) had the best results followed by group D and then group C. Intraperitoneal normal saline offered a detectable benefit to patients undergoing laparoscopic cholecystectomy. The beneficial effect was better when the fluid was suctioned after deflation of the pneumoperitoneum and even better when a subhepatic closed drain continued fluid suction during the first postoperative hours.
腹腔镜手术后，二氧化碳会在腹腔内留存数日，通常会引发疼痛。本前瞻性随机研究旨在确定腹腔内输注生理盐水对腹腔镜胆囊切除术后疼痛的疗效。总共300例患者被随机分为五组，每组60例。A组：对照组，不进行腹腔输注，不放置肝下引流管。B组：不进行腹腔输注，但留置肝下闭式引流管24小时。C组：在右膈下输注25至30毫升/千克体重、温度为37摄氏度的生理盐水，并留存于腹腔内。D组：在右膈下输注室温生理盐水，气腹放气后吸出。E组：同D组一样输注并吸出生理盐水，但留置肝下闭式引流管24小时。术后，在2、6、12、24、48和72小时（住院期间及出院后在家中）测定镇痛药物使用情况、恶心、呕吐及疼痛评分。与对照组相比，C组、D组和E组患者的术后疼痛显著减轻（p<0.001），而A组和B组之间未观察到差异。在C组、D组和E组中，E组（p<0.01）效果最佳，其次是D组，然后是C组。腹腔内输注生理盐水对接受腹腔镜胆囊切除术的患者有明显益处。气腹放气后吸出液体时有益效果更佳，术后最初数小时内肝下闭式引流管持续进行液体抽吸时效果更好。
