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Laparoskopik kolesistektomi sonrası postoperatif ağrının önlenmesinde çoklu bölgeye lokal anestezik infiltrasyonu: ropivakain ve prilokainin plasebo kontrollü karşılaştırılması

Multiregional local anesthesic administration for the prevention of postoperative pain after laparoscopic cholecystectomy: placebo controlled comparison of ropivacaine and prilocaine

Journal Name:

  • Gülhane Tıp Dergisi

Publication Year:

  • 2008

Key Words:

Keywords (Original Language):

Author Name
Abstract (2. Language): 
Although postoperative pain is less often seen in laparoscopic cholecystectomy when compared to conventional surgery, laparoscopic cholecystectomy is not a procedure completely free of pain. The postoperative analgesic effect of intraperitoneal local anesthetic administration during laparoscopic cholecystectomy is still controversial. This prospective randomized study was planned to investigate whether intraperitoneal and port sites administration of ropivacaine and prilocaine has beneficial effects on postoperative analgesia and pulmonary functions and to compare their effects. Forty five ASA I and II patients scheduled for elective laparoscopic cholecystectomy were included in the study. The patients were randomized into 3 groups to receive either a total of 150 mg (80 mL) ropivacaine or a mixture of 400 mg (20 mL) prilocaine (80 mL) or placebo (80 mL saline). Eighty ml were injected into gall bladder, right and left subdiaphragmatic areas and onto visceral periton, and 20 ml, 5 ml each, were injected into around the entry of 4 port sites. Visual analogue scale scores, tramadol consumption, nausea and vomiting, sedation status and SpO2 values were evaluated and recorded immediately at arrival in the postanesthesia care unit, and at 2, 4, 8, 12,18 and 24 h after the surgery. Visual analogue scale scores at rest and after coughing and tramadol consumption at 24 h were significantly lower in the ropivacaine group when compared to the placebo group (p<0.05). There were no ststistically significant differences between the prilocaine and placebo groups (p>0.05). In conclusion, the multiregional intraperitoneal instillation and port site infiltration of ropivacaine, a long acting local anesthetic, after laparoscopic cholecystectomy is a noninvasive, safe and simple technique that reduces the pain and postoperative tramadol consumption. The same effect was not observed with prilocaine administration.
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Abstract (Original Language): 
Postoperatif ağrı laparoskopik kolesistektomide konvansiyonel cerrahiye oranla daha az görülmekle beraber, laparoskopik kolesistektomi tamamen ağrısız bir işlem de değildir. Laparoskopik kolesistektomi süresince intraperitoneal lokal anestezik uygulamasının postoperatif analjezik etkisi halen tartışmalıdır. Bu prospektif ve randomize çalışmayı intraperitoneal ve trokar bölgelerine ropivakain ve prilokain uygulamasının laparoskopik kolesistektomi sonrası ağrının azaltılması ve pulmoner fonksiyonlar üzerine faydasının olup olmadığını görmek ve etkilerini kıyaslamak amacıyla planladık. Elektif laparoskopik kolesistektomi uygulanan 45 ASA-I ve II hasta çalışmaya dahil edildi. Hastalar randomize olarak toplam 150 mg (80 ml) ropivakain veya 400 mg (20 mL) karışımdan 80 mL prilokain veya plasebo (80 mL SF) uygulanacak şekilde 3 gruba ayrıldılar. Seksen ml'si safra kesesi yatağı, sağ ve sol subdiyafragmatik alanlara ve viseral periton yüzeyine, 20 ml ise 4 port giriş yeri etrafına 5'er ml olacak şekilde infiltre edildi. Hasta anestezi sonrası bakım ünitesine alınır alınmaz ve ameliyat sonrası 2, 4, 8, 12, 18 ve 24. saatlerde vizüel ağrı skorlaması skorları, tramadol tüketimi, bulantı ve kusma, sedasyon durumu, SpO2 değerleri değerlendirilip kaydedildi. Yirmi dördüncü saat dinlenme ve öksürük sonrası vizüel ağrı skorlaması skorları ve tramadol ihtiyacı ropivakain grubunda plaseboya oranla anlamlı olarak daha düşük bulunmuştur (p<0.05). Prilokain ve plasebo grupları arasında ise istatistiksel olarak anlamlı farklılık tespit edilmedi (p>0.05). Sonuç olarak; uzun etkili lokal anestezik olan ropivakainin, laparoskopik kolesistektomi sonrası multirejyonel intraperitoneal püskürtme ve port giriş bölgelerine infiltrasyonu, ağrıyı ve ameliyat sonrası tramadol tüketimini azaltan, invaziv olmayan, güvenli ve basit bir tekniktir. Aynı etki prilokain için elde edilmemiştir.
FULL TEXT (PDF): 
PDF icon arastirmax-laparoskopik-kolesistektomi-sonrasi-postoperatif-agrinin-onlenmesinde-coklu-bolgeye-lokal-anestezik-infiltrasyonu-ropivakain-prilokainin-plasebo-kontrollu.pdf
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