腹腔镜胆囊切除术腹腔和静脉途径缓解疼痛

腹腔镜胆囊切除术腹腔和静脉途径缓解疼痛

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作者：雅布尔扈利，萨马岛一Dabbous，阿利亚S. Gerges，弗雷德里克·J.;米雷耶·S.阿扎尔，阿尤布，沙基卜·M.·扈利，Ghattas S.
来源： JSLS，中国的社会Laparoendoscopic外科医生，第9卷，第3号月- 2005年9月第316-321页（6）
发布者：Laparoendoscopic外科医生协会


摘要：
背景：术后腹部和肩部疼痛是最常见的投诉后，择期行腹腔镜胆囊切除术。术后疼痛是多方面的起源，，因此多式联运治疗，可能需要优化缓解疼痛。
方法：我们进行了一项双盲研究中，患者被随机分配到5组，每组20例。统计学显着性P <0.05。第1组40毫升0.25％布比卡因腹腔内喷雾。第2组40毫升0.25％布比卡因腹腔注射200毫克酮洛芬混合喷雾。第3组接受40毫升0.25％布比卡因腹腔内喷雾和静脉注射200毫克酮洛芬。第4组静脉注射200毫克酮洛芬。第5组为对照组。
结果： 5组的人口统计学数据相似。与对照组相比，第1组有显着的下腹部疼痛分数在6小时;组2在0，1，2，和6小时，3组在0，1，2，6，12，和24小时;第4组为2小时。第1组有显着较低的肩部疼痛分数在1小时和6小时，第2组在0和6小时;和组3和4，在0，1，和6小时。组3只的数量的患者需要术后镇痛药，术后呕吐的发生率显着降低。
结论：多模态对疼痛的管理方法择期行腹腔镜胆囊切除术是最好的实现与40毫升0.25％布比卡因腹腔内喷雾和200 mg静脉注射酮洛芬的组合，实现至少术后呕吐的发生率。

Intraperitoneal and Intravenous Routes for Pain Relief in Laparoscopic Cholecystectomy
Authors: Jabbour-Khoury, Samar I.; Dabbous, Aliya S.; Gerges, Frederic J.; Azar, Mireille S.; Ayoub, Chakib M.; Khoury, Ghattas S.
Source: JSLS, Journal of the Society of Laparoendoscopic Surgeons, Volume 9, Number 3, July - September 2005 , pp. 316-321(6)
Publisher: Society of Laparoendoscopic Surgeons

Abstract:
Background: Postoperative abdominal and shoulder pain are the most common complaints after elective laparoscopic cholecystectomy. Postoperative pain is multifactorial in origin, and therefore multimodal therapy may be needed to optimize pain relief.
Methods: We conducted a double-blind study where patients were randomly allocated to 1 of 5 groups of 20 patients each. Statistical significance was considered P<0.05. Group 1 received 40mL bupivacaine 0.25% intraperitoneal spray. Group 2 received 40 mL bupivacaine 0.25% intraperitoneal spray mixed with 200 mg ketoprofen. Group 3 received 40 mL bupivacaine 0.25% intraperitoneal spray and intravenous 200 mg ketoprofen. Group 4 received 200mg ketoprofen intravenously. Group 5 was the control group.
Results: Demographic data were similar in the 5 groups. As compared with the control group, group 1 had significantly lower abdominal pain scores at 6 hours; group 2 at 0, 1, 2, and 6 hours; group 3 at 0, 1, 2, 6, 12, and 24 hours; and group 4 at 2 hours. Group 1 had significantly lower shoulder pain scores at 1 and 6 hours; group 2 at 0 and 6 hours; and groups 3 and 4 at 0, 1, and 6 hours. The number of patients requiring postoperative rescue analgesics and the incidence of postoperative vomiting were significantly lower in group 3 only.
Conclusions: A multimodal approach to pain management following elective laparoscopic cholecystectomy is best achieved with a combination of 40 mL bupivacaine 0.25% intraperitoneal spray and 200 mg intravenous ketoprofen, achieving the least incidence of postoperative vomiting.

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