Efficacy of postoperative continuous wound infiltration with local anesthetic after major abdominal surgery.

Adel R Abadir, Fred Nicolas, Ramiz Gharabawy, Trusha Shah, Rafik Michael
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Abstract

The aim of this study was to evaluate the analgesic efficacy, safety, opioid sparing effects and improvement of respiratory function when using 0.2% ropivacaine continuous wound infiltration after major intra-abdominal surgery. Forty patients undergoing major intra-abdominal surgery requiring a midline incision of > or = 20 cm were enrolled into this IRB-approved, randomized, prospective controlled study. Group 1: 20 patients, parenteral analgesia (control group). Group II: 20 patients, with local anesthetic wound infiltration (pain pump group). At the end of the procedure, in the pain pump group of patients, a multi hole, 20-gauge catheter was inserted percutaneously, above the fascia. An initial dose of 10 ml of 0.2% ropivacaine was injected in the wound through the catheter. A device provided continuous delivery of 0.2% ropivacaine; the infusion was initiated at 6 ml/h for the following two days. The total "rescue" morphine and oxycodone/acetaminophen tablets administered were significantly lower in the pain pump group. At all time intervals, resting pain scores were significantly lower in the pain pump group when compared with the control group. However, at the 4-48 and 12-48 hours pain scores generated after leg raise and coughing, respectively, were significantly lower in group II. The patient vital capacities were insignificantly higher in group II. We conclude that after major abdominal surgery, infiltration and continuous wound instillation with 0.2% ropivacaine decreases postoperative pain, opioid requirements and oral analgesia. Early patient rehabilitation, hastening convalescence, and preventing respiratory complications are expected outcomes of this approach.

局麻对腹部大手术术后持续创面浸润的影响。
本研究的目的是评价0.2%罗哌卡因腹腔内重大手术后伤口持续灌注的镇痛效果、安全性、阿片类药物节约效果及呼吸功能的改善情况。这项经irb批准的随机前瞻性对照研究纳入了40例需要中线切口>或= 20 cm的腹部大手术患者。第一组:20例患者,采用肠外镇痛(对照组)。第二组:20例患者,局部麻醉伤口浸润(痛泵组)。在手术结束时,在疼痛泵组患者中,经皮在筋膜上方插入一根20号的多孔导管。初始剂量10ml 0.2%罗哌卡因通过导管注入创面。装置提供0.2%罗哌卡因的连续输送;开始以6 ml/h滴注,持续2天。镇痛泵组总“抢救”吗啡和羟考酮/对乙酰氨基酚片用量明显降低。在所有时间间隔,疼痛泵组的静息疼痛评分均显著低于对照组。然而,在4-48小时和12-48小时,抬高腿和咳嗽后产生的疼痛评分,II组明显较低。第二组患者的肺活量显著增高。我们得出结论,在腹部大手术后,浸润和持续伤口滴注0.2%罗哌卡因可减少术后疼痛、阿片类药物需求和口服镇痛。早期患者康复,加速康复,预防呼吸系统并发症是这种方法的预期结果。
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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