The Effect of Postoperative Analgesia on the Day-Case Rate of Laparoscopic Cholecystectomy: A Randomised Pilot Study of the Laparoscopic-Assisted Right Subcostal Transversus Abdominis Plane Block plus Local Anaesthetic Wound Infiltration versus Local Anaesthetic Wound Infiltration only.

IF 2.9 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Davide Di Mauro, Alex Reece-Smith, Ikechukwu Njere, Sheena Hubble, Antonio Manzelli
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引用次数: 0

Abstract

Objective: The transversus abdominis plane (TAP) block and local anaesthetic infiltration (LAI) of port sites provide adequate analgesia after laparoscopic cholecystectomy (LC). Little is known if the two techniques affect the day-case (DC) rate of LC. We tested the appropriateness of the research design in view of a larger randomised controlled trial (RCT) - laparoscopic-assisted right subcostal TAP block plus local anaesthetic wound infiltration (STALA) versus LAI.

Subjects and methods: Sixty patients having DC LC were randomised into STALA and LAI. Participants received bupivacaine 0.5% 30 mL. Pain scores were evaluated with the Visual Analogue Scale (VAS) score, at 1 h post-surgery and at discharge. Need of postoperative intravenous (IV) opioids, DC rate, and Quality of Recovery-15 questionnaires were compared between groups and were considered as measures of efficacy of the interventions and follow-up in a definitive trial.

Results: Twenty-nine participants were randomised to STALA, and 31 to LAI. Subjects in LAI group were all women (p = 0.0007) and younger (43.8 vs. 37.7 years, p = 0.023). Median VAS scores were 0 versus 1 at 1 h (p = 0.60), 0 versus 1.5 at discharge (p = 0.55). The need of IV opioids was 15/29 (51.7%) versus 13/31 (41.9%; p = 0.60). The DC rate was 93.1% versus 93.5% (p = 0.39). Fifty (83.3%) participants responded the questionnaires.

Conclusions: The laparoscopically guided right subcostal TAP block provided no additional benefit to LAI on pain control after LC and DC rate. Despite the appropriate design, our findings do not support a larger RCT.

术后镇痛对腹腔镜胆囊切除术日治愈率的影响:腹腔镜辅助右肋下腹横肌平面阻滞加局部麻醉伤口浸润与仅局部麻醉伤口浸润的随机试点研究》,《美国医学会杂志》,2011年第3期。
目的:腹横肌平面(TAP)阻滞和端口部位(LAI)局麻药浸润可在腹腔镜胆囊切除术(LC)后提供充分的镇痛。这两种技术是否会影响腹腔镜胆囊切除术(LC)的日间病例(DC)率,人们知之甚少。我们根据一项更大规模的随机对照试验(RCT)--腹腔镜辅助右肋下TAP阻滞加局部麻醉伤口浸润(STALA)与LAI--测试了研究设计的适当性:60 名直肠癌患者被随机分为 STALA 和 LAI 两组。参与者接受布比卡因 0.5% 30 毫升。在术后 1 小时和出院时使用视觉模拟量表(VAS)对疼痛评分进行评估。对各组术后静脉注射阿片类药物的需要量、DC率和恢复质量-15问卷进行比较,并将其视为衡量干预措施疗效的指标,以及确定性试验中的随访指标:29名参与者被随机分配到STALA组,31名参与者被随机分配到LAI组。LAI 组的受试者均为女性(p = 0.0007),且年龄更小(43.8 岁对 37.7 岁,p = 0.023)。1 小时内 VAS 评分中位数为 0 vs 1(p = 0.60),出院时为 0 vs 1.5(p = 0.55)。需要静脉注射阿片类药物的人数为 15/29 人(51.7%)vs 13/31 人(41.9%;p = 0.60)。直流率为 93.1% vs 93.5%(p = 0.39)。50名参与者(83.3%)回答了调查问卷:结论:腹腔镜引导下的右肋下TAP阻滞与LAI相比,在LC术后疼痛控制和DC率方面没有额外的益处。尽管设计合理,但我们的研究结果并不支持进行更大规模的 RCT 研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Medical Principles and Practice
Medical Principles and Practice 医学-医学:内科
CiteScore
6.10
自引率
0.00%
发文量
72
审稿时长
6-12 weeks
期刊介绍: ''Medical Principles and Practice'', as the journal of the Health Sciences Centre, Kuwait University, aims to be a publication of international repute that will be a medium for dissemination and exchange of scientific knowledge in the health sciences.
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