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Effect of surgical site instillation after laparoscopic urologic surgery

비뇨기과 복강경 수술 후 국소마취제 점적의 효과

  • Hwang, Yong (Depatment of Emergency Medicine, Wonkwang University School of Medicine) ;
  • Shin, Sangyol (Depatment of Emergency Medical Service, Howon University) ;
  • Oh, Tae Hoon (Depatment of Urology Medicine, Wonkwang University School of Medicine)
  • 황용 (원광대학교의과대학 응급의학교실) ;
  • 신상열 (호원대학교 응급구조학과) ;
  • 오태훈 (원광대학교의과대학 비뇨기과학교실)
  • Received : 2018.04.20
  • Accepted : 2018.07.06
  • Published : 2018.07.31

Abstract

The aim of this study was to evaluate the effect of Ropivacaine on pain following laparoscopic surgery. Between March 2015 and June 2017, all 97 patients with renal mass who elected to receive laparoscopic nephrectomy were reviewed, retrospectively. Normal saline (0.9%) was used as a control in 45 patients while Ropivacaine was used for local anesthesia in the instillation group (n=52). Pain score (visual analog scale) of the shoulder and upper abdominal area between the two groups was significantly different between recovery time and 24 h (p<0.05), with no significant differences between 48 and 72 h (both p>0.05). In the instillation group, pain score of shoulder and abdominal pain in the two groups according to the amount of CO2 used was not significantly different between recovery time and 24, 48, and 72 h (all p>0.05). Ropivacaine reduced shoulder and upper abdominal pain that occurred within 24 h after surgery. Effective pain control with Ropivacaine is needed in the early postoperative period when a large amount of CO2 is used in laparoscopic surgery.

본 연구는 비뇨기과 복강경 수술을 받은 환자를 대상으로 수술 부위에 국소마취제인 Ropivacaine을 침윤주사 하였을 때 수술 후 발생하는 어깨 및 상복부 통증에 대한 진통 효과에 대해 알아보고자 하였다. 2015년 3월부터 2017년 6월까지 본원 비뇨기과에서 복강경하 신절제술을 시행 받은 97명의 환자 중에서 수술 부위에 Ropivacaine 침윤주사를 시행 받은 52명의 환자들을 대상으로 하였다. 술 후 통증을 수술 직후, 술 후 24, 48, 72시간의 간격으로 시각 통증 점수를 이용하여 평가하였으며 수술시간, 수술 후 식이섭취 시작, 수술시간, 술 후 재원기간 등을 비교하였다. 어깨와 상복부의 통증 점수가 두 그룹간에 수술 직후와 수술 후 24시간 뒤에 의미 있는 차이가 발생 하였다. 국소마취제를 침윤하지 않은 그룹에서 수술 후 24시간까지 이산화탄소량의 증가에 따라 통증에 차이가 있었으나, 국소마취제를 침윤한 그룹에서는 수술 중 사용한 이산화탄소 양에 따른 통증 차이는 없었다. 국소마취제 주입에 따른 환자들의 보행시기, 식사 시작, 입원 기간에 큰 차이는 없었다. 본 연구 결과 국소마취제 Ropivacaine의 침윤 사용이 복강경 수술 후 24시간까지 어깨 및 상복부 통증의 감소에 효과가 있는 것으로 관찰되었다. 따라서 복강경 수술 중 많은 양의 이산화탄소를 사용한 경우에는 복강경 수술 부위에 Ropivacaine을 사용한 주입법이 술 후 조기에 발생하는 통증을 효과적으로 조절할 수 있다.

Keywords

References

  1. Joris J, Cigarini I, Legrand M, Jacquet N, De Groote D, Franchimont P, Lamy M, "Metabolic and respiratory changes after cholecystectomy performed via laparotomy or laparoscopy", Br J Anaesth., vol. 69, pp. 341-345, 1992. DOI: https://doi.org/10.1093/bja/69.4.341
  2. Tsai HW, Chen YJ, Ho CM, Hseu SS, Chao KC, Tsai SK, Wang PH, "Maneuvers to decrease laparoscopy-induced shoulder and upper abdominal pain: a randomized controlled study", Arch Surg., vol. 146, pp. 1360-1366, 2011. DOI: https://doi.org/10.1001/archsurg.2011.597
  3. Gupta A, "Local anaesthesia for pain relief after laparoscopic cholecystectomy-a systematic review", Best Pract Res Clin Anaesthesiol., vol. 19, pp. 275-292, 2005. DOI: https://doi.org/10.1016/j.bpa.2004.12.007
  4. Cha SM, Kang H, Baek CW, Jung YH, Koo GH, Kim BG, Choi YS, Cha SJ, Cha YJ, "Peritrocal and intraperitoneal ropivacaine for laparoscopic cholecystectomy: a prospective, randomized, double-blind controlled trial", J Surg Res., vol. 175, pp. 251-258, 2012. DOI: https://doi.org/10.1016/j.jss.2011.04.033
  5. Marta Somaini, Pietro Brambillasca, Pablo Mauricio Ingelmo, Lovisari F, Catenacci SS, Rossini V, Bucciero M, Sahillioglu E, Buda A, Signorelli M, Gili M, Joshi G, Fumagalli R, Ferland CE, Diemunsch P, "Effects of Peritoneal Ropivacaine Nebulization for Pain Control After Laparoscopic Gynecologic Surgery", J Minim Invasive Gynecol., vol. 21, pp. 863-869, 2014. DOI: https://doi.org/10.1016/j.jmig.2014.03.021
  6. Wills VL, Hunt DR. "Pain after laparoscopic cholecystectomy", Br J Surg., vol. 87, pp. 273-284, 2000. DOI: https://doi.org/10.1046/j.1365-2168.2000.01374.x
  7. Maestroni U, Sortini D, Devito C, Pour Morad Kohan Brunaldi F, Anania G, Pavanelli L, Pasqualucci A, Donini A, "A new method of preemptive analgesia in laparoscopic cholecystectomy", Surg Endosc., vol. 16, pp. 1336-1340, 2002. DOI: https://doi.org/10.1007/s00464-001-9181-8
  8. Ekstein P, Szold A, Sagie B, Werbin N, Klausner JM, Weinbroum AA, "Laparoscopic surgery may be associated with severe pain and high analgesia requirements in the immediate postoperative period", Ann Surg., vol. 243, pp. 41-46, 2006. DOI: https://doi.org/10.1097/01.sla.0000193806.81428.6f
  9. Cervero F, Laird JM, "Visceral pain", Lancet, vol. 353, pp. 2145-2148, 1999. DOI: https://doi.org/10.1016/S0140-6736(99)01306-9
  10. Goldstein A, Grimault P, Henique A, Keller M, Fortin A, Darai E, "Preventing postoperative pain by local anesthetic instillation after laparoscopic gynecologic surgery: a placebo-controlled comparison of bupivacaine and ropivacaine", Anesth Analg., vol. 91, pp. 403-407, 2000. DOI: https://doi.org/10.1097/00000539-200008000-00032
  11. Kahokehr A, Sammour T, Soop M, Hill AG, "Intraperitoneal use of local anesthetic in laparoscopic cholecystectomy: systematic review and metaanalysis of randomized controlled trials", J Hepatobiliary Pancreat Sci., vol. 17, pp. 637-656, 2010. DOI: https://doi.org/10.1007/s00534-010-0271-7
  12. Louizos AA, Hadzilia SJ, Leandros E, Kouroukli IK, Georgiou LG, Bramis JP, "Postoperative pain relief after laparoscopic cholecystectomy: a placebo-controlled double-blind randomized trial of preincisional infiltration and intraperitoneal instillation of levobupivacaine 0.25%", Surg Endosc., vol. 19, pp. 1503-1506, 2005. DOI: https://doi.org/10.1007/s00464-005-3002-4
  13. Arden D, Seifert E, Donnellan N, Guido R, Lee T, Mansuria S, "Intraperitoneal instillation of bupivacaine for reduction of postoperative pain after laparoscopic hysterectomy: a double-blind randomized controlled trial", J Minim Invasive Gynecol., vol. 20, pp. 620-626, 2013. DOI: https://doi.org/10.1016/j.jmig.2013.03.012
  14. Katz JA, Bridenbaugh PO, Knarr DC, Helton SH, Denson DD, "Pharmacodynamics and pharmacokinetics of epidural ropivacaine in humans", Anesth Analg., vol. 70, pp. 16-21, 1990. DOI: https://doi.org/10.1213/00000539-199001000-00004
  15. Scott DB, Lee A, Fagan D, Bowler GMR, Bloomfield P, Lundh R, "Acute toxicity of ropivacaine compared with that of bupivacaine", Anesth Analg., vol. 69, pp. 5639, 1989. DOI: https://doi.org/10.1213/00000539-198911000-00003
  16. Lui KC, Chow YF, "Safe use of local anaesthetics: prevention and management of systemic toxicity", Hong Kong Med J., vol. 16, pp. 470-475, 2010.