Lokālas ādas incīziju vietas atsāpināšanas efektivitāte sievietēm pēc ginekoloģiskām operācijām

Abstract

Objective: To compare preincisional and preclosure wound analgesia together with intraperitoneal instillation in reducing pain after laparoscopic surgery and analgesic requirement. Materials and Methods: The prospective study included women undergoing any gynaecological laparoscopy with the time limit of 2 hours, who underwent wound analgesia with 10 ml 0,2% ropivacaine undiluted for port-site and diluted intraperitoneally 10 ml 0,2% ropivacaine with 10ml 0,9% normal saline in Latvian Maritime Medicine Centre and were randomized into three groups. Group 1 pre-incisional (n=11), Group 2 pre-closure (n=11) and Group 3 without analgesia (n=11). Pain was assessed using visual analogue scale (VAS) at 2, 6, 12, 24h after surgery. The requirement of rescue analgesics was recorded. Results: A total of 33 women with 11 patients in each group with mean age 37,7 (±10,21) were scheduled for gynaecological laparoscopic surgery. Pain score was largest in all groups 2h after surgery VAS6 (3/11 [27,3%] vs 4/11 [36,4%] vs 3/11 [27,3%]). Patient requirement of additional painkillers was lower in both groups receiving analgesia comparing to control group in all periods after surgery. Most of the patients required pain killers 2h after surgery Group1 vs 2 (5/11 [45,5%] vs 4/10 [40,0%]). No statistical significance was found between preincision and preclosure groups in pain intensity and rescue analgesia requirement. Significantly fewer patients required painkillers for analgesia in the ropivacaine groups than control group- 2h after surgery (p=0.002), 6h after (p=0.005), 12h after (p=0.024), 24h after (p=0.027). Conclusions: Pre-emptive port-site and intraperitoneal anaesthesia is better than no anaesthesia. No difference in time of ropivacaine administration was observed during the study. Combination of pre-emptive port-site plus intraperitoneal ropivacaine to standard postoperative analgesia reduced postoperative additional analgesics requirement in gynaecological laparoscopy.Objective: To compare preincisional and preclosure wound analgesia together with intraperitoneal instillation in reducing pain after laparoscopic surgery and analgesic requirement. Materials and Methods: The prospective study included women undergoing any gynaecological laparoscopy with the time limit of 2 hours, who underwent wound analgesia with 10 ml 0,2% ropivacaine undiluted for port-site and diluted intraperitoneally 10 ml 0,2% ropivacaine with 10ml 0,9% normal saline in Latvian Maritime Medicine Centre and were randomized into three groups. Group 1 pre-incisional (n=11), Group 2 pre-closure (n=11) and Group 3 without analgesia (n=11). Pain was assessed using visual analogue scale (VAS) at 2, 6, 12, 24h after surgery. The requirement of rescue analgesics was recorded. Results: A total of 33 women with 11 patients in each group with mean age 37,7 (±10,21) were scheduled for gynaecological laparoscopic surgery. Pain score was largest in all groups 2h after surgery VAS6 (3/11 [27,3%] vs 4/11 [36,4%] vs 3/11 [27,3%]). Patient requirement of additional painkillers was lower in both groups receiving analgesia comparing to control group in all periods after surgery. Most of the patients required pain killers 2h after surgery Group1 vs 2 (5/11 [45,5%] vs 4/10 [40,0%]). No statistical significance was found between preincision and preclosure groups in pain intensity and rescue analgesia requirement. Significantly fewer patients required painkillers for analgesia in the ropivacaine groups than control group- 2h after surgery (p=0.002), 6h after (p=0.005), 12h after (p=0.024), 24h after (p=0.027). Conclusions: Pre-emptive port-site and intraperitoneal anaesthesia is better than no anaesthesia. No difference in time of ropivacaine administration was observed during the study. Combination of pre-emptive port-site plus intraperitoneal ropivacaine to standard postoperative analgesia reduced postoperative additional analgesics requirement in gynaecological laparoscopy.