Rosaeg O P, Bell M, Cicutti N J, Dennehy K C, Lui A C, Krepski B
Department of Anaesthesia, Ottawa Civic Hospital, University of Ottawa, Ontario, Canada.
Reg Anesth Pain Med. 1998 Nov-Dec;23(6):575-9. doi: 10.1016/s1098-7339(98)90084-0.
To determine the analgesic efficacy of preoperative tumescent infiltration with lidocaine for reduction mammoplasty.
Women with mammary hypertrophy were randomly allocated to one of two study groups in a double-blind clinical trial. Patients in group 1 received preincision infiltration with 5 mL/kg of 0.35% lidocaine with 1:1,000,000 epinephrine into each breast after induction of general anesthesia. Group 2 patients received similar injections of 5 mL/kg of saline with 1:1,000,000 epinephrine. Intravenous patient-controlled analgesia (PCA) morphine (1.0 mg bolus with 5-minute lockout) was available for 9.5 hours in the postoperative period. Visual analog pain scores were recorded during the postoperative period, and hourly morphine consumption data were retrieved from the PCA apparatus. Fitness for discharge was evaluated by the postanesthesia care unit nurse using standardized discharge criteria.
Visual analog pain scores were higher in group 2 patients until 3.5 hours after surgery. Patients in the saline group had higher intravenous morphine consumption during all 1-hour postoperative intervals, although the differences between groups were statistically significant only until 4.5 hours after the operation. Total intravenous morphine consumption during the first 9.5 hours after surgery in group 1 was 16.9+/-11.9 mg versus 31.1+/-18.0 mg in group 2 (P < .05). Postoperative nausea and vomiting occurred with equal frequency (87%) in both study groups, and there was no difference between groups in time to achieve fitness for discharge, i.e., a postanesthesia discharge score of > or = 9.
Preoperative tumescent infiltration with lidocaine results in reduced pain and lower postoperative opioid requirements in the initial hours after reduction mammoplasty.
确定术前用利多卡因进行肿胀麻醉对缩乳术的镇痛效果。
在一项双盲临床试验中，将乳腺肥大的女性随机分配至两个研究组之一。第1组患者在全身麻醉诱导后，于每个乳房注入5 mL/kg含1:1,000,000肾上腺素的0.35%利多卡因进行切口前浸润。第2组患者接受类似的含1:1,000,000肾上腺素的5 mL/kg生理盐水注射。术后9.5小时内可使用静脉自控镇痛（PCA）吗啡（单次推注1.0 mg，锁定时间5分钟）。术后记录视觉模拟疼痛评分，并从PCA装置中获取每小时吗啡消耗数据。麻醉后护理单元护士使用标准化出院标准评估出院适宜性。
术后3.5小时内，第2组患者的视觉模拟疼痛评分较高。在术后所有1小时时间段内，生理盐水组患者的静脉吗啡消耗量均较高，尽管两组之间的差异仅在术后4.5小时内具有统计学意义。术后第1组前9.5小时的静脉吗啡总消耗量为16.9±11.9 mg，第2组为31.1±18.0 mg（P <.05）。两个研究组术后恶心和呕吐的发生率相同（87%），两组在达到出院适宜性的时间上没有差异，即麻醉后出院评分≥9分。
术前用利多卡因进行肿胀麻醉可减轻缩乳术后最初数小时的疼痛，并降低术后阿片类药物需求量。
