日间腹腔镜胆囊切除术多模式镇痛的临床进展_West China Medical Journal

Authors：

 池小薇 ,  朱涛

四川大学华西医院麻醉科成都 610041;

Corresponding author：

朱涛, Email: xwtao_zhu@yahoo.com

Keywords：

日间腹腔镜胆囊切除术; 术后疼痛; 多模式镇痛

DOI：

10.7507/1002-0179.20150619

Video：

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Abstract Full text Figures/Tables Video References Cited by

日间腹腔镜胆囊切除术（ALC）是安全、有效节约资源、提高医院效率的术式，正在逐渐被接受并迅速发展。足够的术后镇痛效果是决定ALC患者术后是否出现疼痛相关并发症、是否可以早期安全离院的重要因素。多模式镇痛是伍用不同镇痛药物或镇痛方法，有效减少伤害刺激及其应激反应，稳定机体内环境，同时较单模式镇痛具有更少副作用，以实现最佳镇痛效果，提高患者术后恢复质量。ALC患者24 h内离院的特殊性，促使国内外ALC围手术期镇痛技术已逐渐由单模式镇痛向多模式镇痛转变。现探讨ALC术后疼痛特点及疼痛产生机制，并对目前ALC多模式镇痛现状及其进展作一综述，进而对其发展趋势进行展望，为临床ALC合理运用多模式镇痛提供参考。

Citation： 池小薇, 朱涛. 日间腹腔镜胆囊切除术多模式镇痛的临床进展. West China Medical Journal, 2015, 30(11): 2175-2178. doi: 10.7507/1002-0179.20150619 Copy

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2.	Voitk AJ. Is outpatient cholecystectomy safe for the higher-risk elective patient?[J]. Surg Endosc, 1997, 11(12):1147-1149.
3.	Lam D, Miranda R, Hom SJ. Laparoscopic cholecystectomy as an outpatient procedure[J]. J Am Coll Surg, 1997, 185(2):152-155.
4.	Wills VL, Hunt DR. Pain after laparoscopic cholecystectomy[J]. Br J Surg, 2000, 87(3):273-284.
5.	Elvir-Lazo OL, White PF. Postoperative pain management after ambulatory surgery:role of multimodal analgesia[J]. Anesthesiol Clin, 2010, 28(2):217-224.
6.	Bisgaard T. Analgesic treatment after laparoscopic cholecystectomy:a critical assessment of the evidence[J]. Anesthesiology, 2006, 104(4):835-846.
7.	余骏马, 张野. 罗哌卡因在腹腔镜胆囊切除术后镇痛中选择的必要性[J]. 国际麻醉学与复苏杂志, 2013, 34(9):843-845, 850.
8.	Sarli L, Costi R, Sansebastiano G. Mini-laparoscopic cholecystectomy vs laparoscopic cholecystectomy[J]. Surg Endosc, 2001, 15(6):614-618.
9.	Davides D, Birbas K, Vezakis A, et al. Routine low-pressure pneumoperitoneum during laparoscopic cholecystectomy[J]. Surg Endosc, 1999, 13(9):887-889.
10.	王振显, 曹月敏, 常迎彬, 等. 氧气置换对腹腔镜胆囊切除术后肩部疼痛原因的临床研究[J]. 中华外科杂志, 2001, 39(11):858-860.
11.	Wallace DH, Serpell MG, Baxter JN, et al. Randomized trial of different insufflation pressures for laparoscopic cholecystectomy[J]. Br J Surg, 1997, 84(4):455-458.
12.	陈刚亮, 徐卫红. 腹腔镜胆囊切除术后疼痛原因分析[J]. 浙江实用医学, 2004, 9(6):440-441.
13.	Aitola P, Airo I, Kaukinen S, et al. Comparison of N₂O and CO₂ pneumoperitoneums during laparoscopic cholecystectomy with special reference to postoperative pain[J]. Surg Laparosc Endosc, 1998, 8(2):140-144.
14.	于硕鹏. 腹腔镜胆囊切除术75例病人术后急性炎症应激反应研究[J]. 中外医疗, 2014, 33(13):117-118.
15.	Kimura T, Suzuki K, Umehara Y, et al. Features and management of bile leaks after laparoscopic cholecystectomy[J]. J Hepatobiliary Pancreat Surg, 2005, 12(1):61-64.
16.	Skinner HB. Multimodal acute pain management[J]. Am J Orthop (Belle Mead NJ), 2004, 33(Suppl 5):5-9.
17.	Pappas-Gogos G, Tsimogiannis KE, Zikos N, et al. Preincisional and intraperitoneal ropivacaine plus normal saline infusion for postoperative pain relief after laparoscopic cholecystectomy:a randomized double-blind controlled trial[J]. Surg Endosc, 2008, 22(9):2036-2045.
18.	Papagiannopoulou P, Argiriadou H, Georgiou M, et al. Preincisional local infiltration of levobupivacaine vs ropivacaine for pain control after laparoscopic cholecystectomy[J]. Surg Endosc, 2003, 17(12):1961-1964.
19.	陆慧红, 白浪, 赵宇鹏, 等. 帕瑞昔布结合切口局麻用于腹腔镜胆囊切除术后的镇痛效果[J]. 国际麻醉学与复苏杂志, 2011, 32(4):417-418, 423.
20.	陈江山, 曾思, 文传兵, 等. 罗哌卡因切口预注射联合曲马多对腹腔镜下胆囊切除术后疼痛的影响[J]. 华西医学, 2011, 26(12):1864-1867.
21.	Szem JW, Hydo L, Barie PS. A double-blinded evaluation of intraperitoneal bupivacaine vs saline for the reduction of postoperative pain and nausea after laparoscopic cholecystectomy[J]. Surg Endosc, 1996, 10(1):44-48.
22.	Sozbilen M, Yeniay L, Unalp M, et al. Effects of ropivacaine on pain after laparoscopic cholecystectomy:a prospective, randomized study[J]. Adv Ther, 2007, 24(2):247-257.
23.	Carney J, McDonnell JG, Ochana A, et al. The transversus abdominis plane block provides effective postoperative analgesia in patients undergoing total abdominal hysterectomy[J]. Anesth Analg, 2008, 107(6):2056-2060.
24.	Latzke D, Marhofer P, Kettner SC, et al. Pharmacokinetics of the local anesthetic ropivacaine after transversus abdominis plane block in healthy volunteers[J]. Eur J Clin Pharmacol, 2012, 68(4):419-425.
25.	Kadam VR, Moran JL. Epidural infusions versus transversus abdominis plane (TAP) block infusions:retrospective study[J]. J Anesth, 2011, 25(5):786-787.
26.	Abdallah FW, Brull R. Is sciatic nerve block advantageous when combined with femoral nerve block for postoperative analgesia following total knee arthroplasty? A systematic review[J]. Reg Anesth Pain Med, 2011, 36(5):493-498.
27.	张学政, 王权光, 周颖, 等. 超声引导腹横肌平面阻滞用于改善腹腔镜胆囊切除术后镇痛质量的临床观察[J]. 北京医学, 2013, 35(4):275-277.
28.	Scott LJ, Perry CM. Tramadol:a review of its use in perioperative pain[J]. Drugs, 2000, 60(1):139-176.
29.	李快春, 马剑锋, 徐坚, 等. 曲马多对异丙酚吸入麻醉下小儿日间手术术后镇痛的影响[J]. 温州医学院学报, 2004, 34(4):298-299.
30.	Sacerdote P, Bianchi M, Gaspani L, et al. The effects of tramadol and morphine on immune responses and pain after surgery in cancer patients[J]. Anesth Analg, 2000, 90(6):1411-1414.
31.	Abraham NS, Hlatky MA, Antman EM, et al. ACCF/ACG/AHA 2010 expert consensus document on the concomitant use of proton pump inhibitors and thienopyridines:a focused update of the ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use a report of the American college of cardiology foundation task force on expert consensus documents[J]. J Am Coll Cardiol, 2010, 56(24):2051-2066.
32.	邓小明, 姚尚龙, 于布为, 等. 现代麻醉学[M]. 北京:人民卫生出版社, 2014:542-566.
33.	De Oliveira GS, Ahmad S, Fitzgerald PC, et al. Dose ranging study on the effect of preoperative dexamethasone on postoperative quality of recovery and opioid consumption after ambulatory gynaecological surgery[J]. Br J Anaesth, 2011, 107(3):362-371.
34.	Bigat Z, Boztug N, Hadimioglu N, et al. Does dexamethasone improve the quality of intravenous regional anesthesia and analgesia? A randomized, controlled clinical study[J]. Anesth Analg, 2006, 102(2):605-609.
35.	Sistla S, Rajesh R, Sadasivan J, et al. Does single-dose preoperative dexamethasone minimize stress response and improve recovery after laparoscopic cholecystectomy?[J]. Surg Laparosc Endosc Percutan Tech, 2009, 19(6):506-510.
36.	戴体俊. 麻醉药理学[M]. 北京:人民卫生出版社, 2005:80-81.
37.	Launo C, Bassi C, Spagnolo L, et al. Preemptive ketamine during general anesthesia for postoperative analgesia in patients undergoing laparoscopic cholecystectomy[J]. Minerva Anestesiol, 2004, 70(10):727-734; 734-8.
38.	Lin TF, Yeh YC, Lin FS, et al. Effect of combining dexmedetomidine and morphine for intravenous patient-controlled analgesia[J]. Br J Anaesth, 2009, 102(1):117-122.
39.	Guler G, Akin A, Tosun Z, et al. Single-dose dexmedetomidine attenuates airway and circulatory reflexes during extubation[J]. Acta Anaesthesiol Scand, 2005, 49(8):1088-1091.

1. Reynolds WJ. The first laparoscopic cholecystectomy[J]. JSLS, 2001, 5(1):89-94.
2. Voitk AJ. Is outpatient cholecystectomy safe for the higher-risk elective patient?[J]. Surg Endosc, 1997, 11(12):1147-1149.
3. Lam D, Miranda R, Hom SJ. Laparoscopic cholecystectomy as an outpatient procedure[J]. J Am Coll Surg, 1997, 185(2):152-155.
4. Wills VL, Hunt DR. Pain after laparoscopic cholecystectomy[J]. Br J Surg, 2000, 87(3):273-284.
5. Elvir-Lazo OL, White PF. Postoperative pain management after ambulatory surgery:role of multimodal analgesia[J]. Anesthesiol Clin, 2010, 28(2):217-224.
6. Bisgaard T. Analgesic treatment after laparoscopic cholecystectomy:a critical assessment of the evidence[J]. Anesthesiology, 2006, 104(4):835-846.
7. 余骏马, 张野. 罗哌卡因在腹腔镜胆囊切除术后镇痛中选择的必要性[J]. 国际麻醉学与复苏杂志, 2013, 34(9):843-845, 850.
8. Sarli L, Costi R, Sansebastiano G. Mini-laparoscopic cholecystectomy vs laparoscopic cholecystectomy[J]. Surg Endosc, 2001, 15(6):614-618.
9. Davides D, Birbas K, Vezakis A, et al. Routine low-pressure pneumoperitoneum during laparoscopic cholecystectomy[J]. Surg Endosc, 1999, 13(9):887-889.
10. 王振显, 曹月敏, 常迎彬, 等. 氧气置换对腹腔镜胆囊切除术后肩部疼痛原因的临床研究[J]. 中华外科杂志, 2001, 39(11):858-860.
11. Wallace DH, Serpell MG, Baxter JN, et al. Randomized trial of different insufflation pressures for laparoscopic cholecystectomy[J]. Br J Surg, 1997, 84(4):455-458.
12. 陈刚亮, 徐卫红. 腹腔镜胆囊切除术后疼痛原因分析[J]. 浙江实用医学, 2004, 9(6):440-441.
13. Aitola P, Airo I, Kaukinen S, et al. Comparison of N₂O and CO₂ pneumoperitoneums during laparoscopic cholecystectomy with special reference to postoperative pain[J]. Surg Laparosc Endosc, 1998, 8(2):140-144.
14. 于硕鹏. 腹腔镜胆囊切除术75例病人术后急性炎症应激反应研究[J]. 中外医疗, 2014, 33(13):117-118.
15. Kimura T, Suzuki K, Umehara Y, et al. Features and management of bile leaks after laparoscopic cholecystectomy[J]. J Hepatobiliary Pancreat Surg, 2005, 12(1):61-64.
16. Skinner HB. Multimodal acute pain management[J]. Am J Orthop (Belle Mead NJ), 2004, 33(Suppl 5):5-9.
17. Pappas-Gogos G, Tsimogiannis KE, Zikos N, et al. Preincisional and intraperitoneal ropivacaine plus normal saline infusion for postoperative pain relief after laparoscopic cholecystectomy:a randomized double-blind controlled trial[J]. Surg Endosc, 2008, 22(9):2036-2045.
18. Papagiannopoulou P, Argiriadou H, Georgiou M, et al. Preincisional local infiltration of levobupivacaine vs ropivacaine for pain control after laparoscopic cholecystectomy[J]. Surg Endosc, 2003, 17(12):1961-1964.
19. 陆慧红, 白浪, 赵宇鹏, 等. 帕瑞昔布结合切口局麻用于腹腔镜胆囊切除术后的镇痛效果[J]. 国际麻醉学与复苏杂志, 2011, 32(4):417-418, 423.
20. 陈江山, 曾思, 文传兵, 等. 罗哌卡因切口预注射联合曲马多对腹腔镜下胆囊切除术后疼痛的影响[J]. 华西医学, 2011, 26(12):1864-1867.
21. Szem JW, Hydo L, Barie PS. A double-blinded evaluation of intraperitoneal bupivacaine vs saline for the reduction of postoperative pain and nausea after laparoscopic cholecystectomy[J]. Surg Endosc, 1996, 10(1):44-48.
22. Sozbilen M, Yeniay L, Unalp M, et al. Effects of ropivacaine on pain after laparoscopic cholecystectomy:a prospective, randomized study[J]. Adv Ther, 2007, 24(2):247-257.
23. Carney J, McDonnell JG, Ochana A, et al. The transversus abdominis plane block provides effective postoperative analgesia in patients undergoing total abdominal hysterectomy[J]. Anesth Analg, 2008, 107(6):2056-2060.
24. Latzke D, Marhofer P, Kettner SC, et al. Pharmacokinetics of the local anesthetic ropivacaine after transversus abdominis plane block in healthy volunteers[J]. Eur J Clin Pharmacol, 2012, 68(4):419-425.
25. Kadam VR, Moran JL. Epidural infusions versus transversus abdominis plane (TAP) block infusions:retrospective study[J]. J Anesth, 2011, 25(5):786-787.
26. Abdallah FW, Brull R. Is sciatic nerve block advantageous when combined with femoral nerve block for postoperative analgesia following total knee arthroplasty? A systematic review[J]. Reg Anesth Pain Med, 2011, 36(5):493-498.
27. 张学政, 王权光, 周颖, 等. 超声引导腹横肌平面阻滞用于改善腹腔镜胆囊切除术后镇痛质量的临床观察[J]. 北京医学, 2013, 35(4):275-277.
28. Scott LJ, Perry CM. Tramadol:a review of its use in perioperative pain[J]. Drugs, 2000, 60(1):139-176.
29. 李快春, 马剑锋, 徐坚, 等. 曲马多对异丙酚吸入麻醉下小儿日间手术术后镇痛的影响[J]. 温州医学院学报, 2004, 34(4):298-299.
30. Sacerdote P, Bianchi M, Gaspani L, et al. The effects of tramadol and morphine on immune responses and pain after surgery in cancer patients[J]. Anesth Analg, 2000, 90(6):1411-1414.
31. Abraham NS, Hlatky MA, Antman EM, et al. ACCF/ACG/AHA 2010 expert consensus document on the concomitant use of proton pump inhibitors and thienopyridines:a focused update of the ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use a report of the American college of cardiology foundation task force on expert consensus documents[J]. J Am Coll Cardiol, 2010, 56(24):2051-2066.
32. 邓小明, 姚尚龙, 于布为, 等. 现代麻醉学[M]. 北京:人民卫生出版社, 2014:542-566.
33. De Oliveira GS, Ahmad S, Fitzgerald PC, et al. Dose ranging study on the effect of preoperative dexamethasone on postoperative quality of recovery and opioid consumption after ambulatory gynaecological surgery[J]. Br J Anaesth, 2011, 107(3):362-371.
34. Bigat Z, Boztug N, Hadimioglu N, et al. Does dexamethasone improve the quality of intravenous regional anesthesia and analgesia? A randomized, controlled clinical study[J]. Anesth Analg, 2006, 102(2):605-609.
35. Sistla S, Rajesh R, Sadasivan J, et al. Does single-dose preoperative dexamethasone minimize stress response and improve recovery after laparoscopic cholecystectomy?[J]. Surg Laparosc Endosc Percutan Tech, 2009, 19(6):506-510.
36. 戴体俊. 麻醉药理学[M]. 北京:人民卫生出版社, 2005:80-81.
37. Launo C, Bassi C, Spagnolo L, et al. Preemptive ketamine during general anesthesia for postoperative analgesia in patients undergoing laparoscopic cholecystectomy[J]. Minerva Anestesiol, 2004, 70(10):727-734; 734-8.
38. Lin TF, Yeh YC, Lin FS, et al. Effect of combining dexmedetomidine and morphine for intravenous patient-controlled analgesia[J]. Br J Anaesth, 2009, 102(1):117-122.
39. Guler G, Akin A, Tosun Z, et al. Single-dose dexmedetomidine attenuates airway and circulatory reflexes during extubation[J]. Acta Anaesthesiol Scand, 2005, 49(8):1088-1091.

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日间腹腔镜胆囊切除术多模式镇痛的临床进展

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