Experience with irrigation analgesia after abdominal hysterectomy
https://doi.org/10.17650/1994-4098-2012-0-3-4-139-146
Abstract
A prospective randomized clinical trial was performed in 100 patients who underwent abdominal hysterectomy under endotracheal anesthesia based on sevoflurane and fentanyl. Intraoperatively, ketorolac 30 mg was administered intramuscularly after induction of anesthesia and paracetamol 1 g was injected intravenously 30–40 minutes prior to surgical termination in a control group (n = 25). For postoperative anal- gesia, promedol, tramadol, and ketorolac were used intramuscularly and paracetamol was given intravenously. Three study groups (n = 2 in each) differed from the control group in that during wound suturing a multiperforated catheter was placed above the peritoneum over a length of 15 cm, through which a 10-ml bolus of 0.75 % ropivacaine was first administered, followed by continuous infusion of 0.2 % ropivacaine at a rate of 8 ml/hour for 36 hours. In one irrigation group, ketorolac 30 mg was injected intramuscularly t.i.d. for 2 days; in another group, the agent was added to a ropivacaine solution calculated with reference to 180 mg for 2 days; in the third group, ketoprofen 100 mg instead of ketorolac was used b.i.d. for 2 days. Pain level (by digital rating scale, 0–10) and the need for analgesics were measured. There was no sta- tistical significant difference in the level of pain and the need for analgesics between the wound irrigation and control groups.
About the Author
R. V. Garyaev
N.N. Blokhin Russian Cancer Research Center, Russian Academy of Medical Sciences, Moscow
Russian Federation
Russian Federation
References
1. Аксель Е.М. Статистика злокачественных новообразований женских половых органов. ОЖРС 2009;1−2:76−80.
2. Осипова Н.А., Абузарова Г.Р., Петрова В.В. Принципы клинического применения наркотических и ненаркотических анальгетических средств при острой и хронической боли. М.: МНИОИ им. П.А. Герцена, 2004. 64 с.
3. Jensen K., Kehlet H., Lund C.M. Postoperative recovery profile after elective abdominal hysterectomy: a prospective, observational study of a multimodal anaesthetic regime. EJA 2009;26(5):382−8.
4. Гаряев Р.В. Наркоз и обезболивание в онкогинекологии. ОЖРС 2010;3:50−6.
5. Уваров Д.Н., Земцовский М.Я., Волкова И.Г. и др. Введение местных анестетиков в рану: так ли нам нужен еще один метод обезболивания в оперативном акушерстве? Мат. IV съезда Федерации анес- тезиологов-реаниматологов Приволжского федерального округа «Анестезия и интенсивная терапия в специализированных областях». Н. Новгород, 2010. С. 113−114.
6. Hollmann M.W., Durieux M.E. Local anesthetics and the inflammatory response: a new therapeutic indication? Anesthesiology 2000;93:858−75.
7. Liu S.S., Richman J.M., Thirlby R.C. et al. Efficacy of continuous wound catheters delivering local anesthetic for postoperative analgesia: a quantitative and qualitative systematic review of randomized
8. controlled trials. J Am Coll Surg 2006; 203(6):914−32.
9. Mecklem D.W., Humphey M.D., Hicks R.W. Efficacy of bupivacaine delivered by wound catheter for post-caesarean section analgesia. Aust N Z J Obstet Gynaecol 1995;35:416−21.
10. Fredman B., Shapiro A., Zohar E. et al. The analgesic efficacy of patient-controlled ropivacaine instillation after Cesarean delivery. Anesth Analg 2000;91:1436−40.
11. Givens V.A., Lipscomb G.H., Meyer N.L. A randomized trial of postoperative wound irrigation with local anesthetic for pain after cesarean delivery. Am J Obstet Gynecol 2002; 186:1188−91.
12. Kristensen B.B., Chistensen D.S., Ostergaard M. et al. Lack of postoperative pain relief after hysterectomy using preperitoneally administered bupivacaine. Reg Anesth Pain Med 1999;24:576−80.
13. Zohar E., Fredman B., Phillipov A. et al. The analgesic efficacy of patient-controlled bupivacaine wound instillation after total abdo- minal hysterectomy with bilateral salpingo- oophorectomy. Anesth Analg 2001;93:482−7.
14. Leong W.M., Lo W.K., Chiu J.W. Analgesic efficacy of continuous delivery of bupivacaine by an elastomeric balloon infusor after abdominal hysterectomy: a prospective randomised controlled trial. Aust N Z
15. J Obstet Gynaecol 2002;42:515−8.
16. Gupta A., Perniola A., Axelsson K. et al. Postoperative pain after abdominal hyster- ectomy: a double-blind comparison between placebo and local anesthetic infused intra- peritoneally. Anesth Analg 2004;99:1173−9.
17. Kushner D.M., LaGalbo R., Connor J.P. et al. Use of a bupivacaine continuous wound infusion system in gynecologic oncology: a randomized trial. Obstet Gynecol 2005; 106:227−33.
Review
For citations:
Garyaev R.V. Experience with irrigation analgesia after abdominal hysterectomy. Tumors of female reproductive system. 2012;(3-4):139-146. (In Russ.) https://doi.org/10.17650/1994-4098-2012-0-3-4-139-146
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