目的:一些接受腹腔镜子宫切除术的患者要求入院过夜进行疼痛管理,因此增加了当天出院安全的手术成本。我们想评估腹腔镜宫颈上子宫切除术前布比卡因与肾上腺素的宫颈旁阻滞是否会降低过夜入院率,术后疼痛,和止痛药的需求。
方法:这是一个随机的,双盲,安慰剂对照,在学术医学中心进行的平行组试验(加拿大工作组分类I)。接受腹腔镜宫颈上子宫切除术的患者在皮肤切开前随机分为20mL宫颈旁注射0.25%布比卡因和肾上腺素或20mL生理盐水。所有提供商,除了循环护士,被蒙蔽了。主要结果是过夜住院率。次要结果包括术后疼痛药物使用和疼痛评分。分析包括t检验,χ2,Wilcoxon,和ANOVA。
结果:招募了一百三十二名患者,其中68名患者为治疗组,64名患者为安慰剂组。组间人口统计学相似。治疗组的计划外过夜入院率为34%,安慰剂组为27%(P=0.25)。放电后,治疗组平均使用8.5片麻醉药,而安慰剂组使用11.7片(P=.07)。治疗组服用13.1片非麻醉性镇痛药,安慰剂组为11.2片(P=0.57)。两组的疼痛评分相似。
结论:腹腔镜下宫颈全切除术前使用布比卡因和肾上腺素的宫颈旁阻滞并没有降低患者的住院时间或影响术后疼痛。术后阿片类药物的使用最低限度地减少。
OBJECTIVE: Some patients who undergo laparoscopic hysterectomy request overnight admission for pain management, thus increasing costs for a surgery that is safe for same-day discharge. We wanted to evaluate whether a paracervical block of bupivacaine with epinephrine before laparoscopic supracervical hysterectomy would decrease overnight admission rates, postoperative pain, and pain medication requirement.
METHODS: This was a randomized, double-blind, placebo-controlled, parallel-group trial (Canadian Task Force classification I) at an academic medical center. Patients undergoing laparoscopic supracervical hysterectomy were randomized to a 20-mL paracervical injection of either 0.25% bupivacaine with epinephrine or 20 mL normal saline before skin incision. All providers, except the circulating nurse, were blinded. The primary outcome was overnight hospital admission rate. Secondary outcomes included postoperative pain medication use and pain scores. Analysis included t test, χ2, Wilcoxon, and ANOVA.
RESULTS: One hundred thirty-two patients were enrolled-68 in the treatment group and 64 in the placebo group. Demographics were similar between groups. The unplanned overnight admission rate was 34% for the treatment group and 27% for the placebo group (P = .25). After discharge, the treatment group used on average 8.5 tablets of narcotics, whereas the placebo group used 11.7 tablets (P = .07). The treatment group took 13.1 tablets of nonnarcotic analgesics compared to 11.2 in the placebo group (P = .57). Both groups reported similar pain scores.
CONCLUSIONS: Paracervical block with bupivacaine and epinephrine before laparoscopic supracervical hysterectomy did not decrease overnight admission rate or affect postoperative pain. Postoperative opiate use was minimally decreased.