instillation of local anesthetic has been shown to be effective in reducing postoperative pain after abdominal surgery. We sought to investigate the e

Size: px

Start display at page:

Download "instillation of local anesthetic has been shown to be effective in reducing postoperative pain after abdominal surgery. We sought to investigate the e"

姹全
5 years ago
Views:

1 文献进展摘要及翻译贵州医科大学麻醉学系研究生 ( 心电生理及记忆课题组 ) 文献名 :( 英文 )Intraperitoneal Instillation of Lidocaine Improves Postoperative Analgesia at Cesarean Delivery: A Randomized, Double-Blind, Placebo-Controlled Trial ( 中文 ) 腹腔注射利多卡因改善剖宫产术后镇痛 : 随机双盲安慰剂对照试验译者 : 赵怀彪 Abstract: BACKGROUND: Cesarean delivery is a commonly performed procedure worldwide. Despite improvements in balanced multimodal analgesia, there remains a proportion of women for whom postoperative pain relief and patient satisfaction are still inadequate. Intraperitoneal

2 instillation of local anesthetic has been shown to be effective in reducing postoperative pain after abdominal surgery. We sought to investigate the effect of intraperitoneal instillation of lidocaine on postcesarean delivery pain as part of a multimodal analgesia regimen. METHODS: We studied women scheduled for elective cesarean delivery under spinal anesthesia.spinal anesthesia was performed with 0.75% hyperbaric bupivacaine, fentanyl, and morphine.at the end of the cesarean delivery, immediately before parietal peritoneum or fascia closure, patients were randomized to receive either lidocaine (20 ml 2% lidocaine with epinephrine) or placebo (20 ml normal saline) instilled into the peritoneal cavity. The primary outcome was pain score on movement at 24 hours. Secondary outcomes were pain score at rest and on movement at 2, 24, and 48 hours; maternal satisfaction score; analgesic consumption;incidence of nausea, vomiting, and itching; and return of bowel function.

3 RESULTS: Two hundred four women were recruited. Baseline characteristics were similar between the lidocaine and placebo groups. Pain scores at 24 hours postcesarean delivery on movement (parameter estimate 0.02 [95% confidence interval {CI} 0.14 to 0.18]; P =.823) and at rest (parameter estimate 0.00 [95% CI 0.32 to 0.33]; P =.986) were similar in both groups. Pain scores at 2 hours postcesarean delivery on movement (parameter estimate 0.58[95% CI 0.90 to 0.26]; P =.001) and at rest (parameter estimate 1.00 [95% CI 1.57 to 0.43]; P =.001) were lower in the lidocaine group. Subgroup analysis of patients with peritoneum closure revealed significantly lower pain scores at 24 hours on movement (parameter estimate 0.33 [95% CI 0.64 to 0.03]; P =.032) in the lidocaine group. The number of women requesting postoperative opioids for breakthrough pain was significantly lower in the lidocaine group compared with that of the placebo (40 [40%] vs 61 [65%], respectively, relative

4 risk 0.59 [95% CI ]; P = 0.001). CONCLUSIONS: The use of intraperitoneal instillation of lidocaine improves early postoperative pain management after cesarean delivery. Furthermore, it reduces the number of women requesting systemic opioids in the immediate postpartum period. Women undergoing peritoneal closure may particularly benefit from this intervention. 摘要翻译 : 背景 : 剖宫产是全世界常见的手术尽管平衡多模态镇痛方面有所改善, 但仍有一部分妇女的术后疼痛缓解和患者满意度仍然不足局部麻醉剂的腹膜内滴注已经展示能有效减少腹部手术术后疼痛我们试图调查作为多模式镇痛方案的一部分的腹膜内滴注利多卡因对剖宫产术后分娩痛的影响方法 : 我们研究安排在脊髓麻醉下选择性剖腹产妇女使用 0.75% 高比重布比卡因芬太尼, 吗啡进行脊髓麻醉在剖宫产分娩结束时, 立即在壁层腹膜或筋膜闭合之前, 将患者随机分配接受利多卡因 (20mL 2% 利多卡因与肾上腺素 ) 或安慰剂 ( 20 ml 生理盐水 ) 滴入腹膜腔主要结果是术后 24 小时运动疼痛评分次要结

5 果是静息时和在 2 24 和 48 小时的运动疼痛评分 ; 产妇满意度得分 ; 止痛消耗 ; 恶心, 呕吐和瘙痒的发生率 ; 肠功能恢复结果 : 研究纳入二百零四名女性利多卡因和安慰剂组的基线特征相似剖宫产分娩术后 24 小时运动疼痛评分 ( 参数估计 0.02 [ 95% 可信区间 {CI} 0.14 至 0.18 ];P = 823) 和静止 ( 参数估计 0 [95% 可信区间 0.32 至 0.33;P = 986) 两组相似利多卡因组术后 2 小时的运动疼痛评分 ( 参数估计 0.58 [ 95% 可信区间 ] 0.90 至 -0.26;P = 001) 和静止 ( 参数估计 1 [ 95% ] CI 1.57 到 0.43;P = 001) 均较低腹膜闭合患者的亚组分析显示利多卡因组在运动 24 小时时的疼痛评分显著降低 ( 参数估计 [95%CI 至 -0.03]; P = 0.032) 利多卡因组术后爆发性疼痛接受阿片类药物的妇女数量显着低于安慰剂组,(40 [ 40% ] 比 61 [ 65% ], 相对危险度为 0.59 [95% 可信区间 0.43 至 0.81]; P = ) 结论 : 腹膜内滴注利多卡因改善了剖腹产后早期术后疼痛管理此外, 它减少了在产后立即要求系统性阿片类药物的妇女人数接受腹膜闭合的妇女可能特别受益于这种干预图表 :

8 文献概要 :Ruchira Patel, MBBS,* Jose C. A. Carvalho, MD, PhD, et al.intraperitoneal Instillation of Lidocaine Improves Postoperative Analgesia at Cesarean Delivery: A Randomized, Double-Blind, Placebo- Controlled Trial[J].Anesth Analg 2017;124:554 9 备注 : 1.. 请按照规定格式补充相关资料, 字体请设置为黑体 2. 图表是指文献中的重要的图和表格 3. 文献概要请使用参考文献格式, 为 : 作者名 + 文献名 + 杂志 + 发表月份如 : 高鸿. 束支传导阻滞病人围麻醉期处理策略 [A]. 贵州省医学会麻醉学分会.2014 年贵州省医学会麻醉学分会学术年会暨贵州省第五次临床麻醉质量控制会议论文汇编 [C]. 贵州省医学会麻醉学分会 :,2014:4

醫學新知 (I) 35 11.74 mm Hg 2. 50% 3. SYMPLICITY HTN-III study 26% 4. 5. SYMPLICITY HTN-I SYMPLICITY HTN-II SYMPLICITY HTN-III 6 A controlled trial of

醫學新知 (I) 35 11.74 mm Hg 2. 50% 3. SYMPLICITY HTN-III study 26% 4. 5. SYMPLICITY HTN-I SYMPLICITY HTN-II SYMPLICITY HTN-III 6 A controlled trial of 34 醫學新知 (I) 針對頑固性高血壓之腎動脈交感神經阻斷術控制研究編譯 : 王宇澄中國醫藥大學附設醫院心臟內科 2:1 6 24 70% 535 14.13±23.93 mm Hg 11.74±25.94 mm Hg ( p