OBJECTIVE:To assess the effect of preoperative local anaesthesia with ropivacaine and find out if there was a dose-response relationship with postoperative pain after inguinal hernia repair.

DESIGN:Randomised, double-blind, placebo-controlled trial.

SETTING:Two Swedish and two Norwegian hospitals.

SUBJECTS:131 Male patients undergoing elective inguinal hernia repair.

INTERVENTION:Infiltration of the inguinal field before operation with 0.5% ropivacaine 40 ml (200 mg), 0.25% ropivacaine 40 ml (100 mg) or saline 40 ml.

MAIN OUTCOME MEASURES:Wound pain at rest and during mobilisation, pressure exerted to reach pain threshold and maximum pain tolerance after 3, 6, 10, and 24 hours, and after 7 days; consumption of analgesics; and Quality of Life assessed by two independent questionnaires before and after operation.

RESULTS:Pain scores after 3 hours were significantly lower in the ropivacaine groups compared with the saline group for all variables (p < 0.05). At 6 hours pain scores were significantly lower for ropivacaine 0.5% compared with saline for wound pain during mobilisation and pressure exerted to reach maximum pain tolerance. Patients given saline made their first request for analgesics significantly sooner than in the other two groups (p < 0.05), and a significantly larger percentage of them requested analgesics during the first 24 hours (p < 0.05). Evaluation of the Quality of Life questionnaires showed no significant differences between the groups.

CONCLUSION:Ropivacaine has a significant, dose-related pain-reducing effect in the immediate postoperative period but we could find no support for the theory that preoperative infiltration analgesia reduces long term pain.

译文

目的 : 评估罗哌卡因术前局部麻醉的效果,并找出腹股沟疝修补术后疼痛是否存在剂量反应关系。
设计 : 随机,双盲,安慰剂对照试验。
设置 : 两家瑞典医院和两家挪威医院。
受试者 :131例接受选择性腹股沟疝修补术的男性患者。
干预 : 术前用0.5% 罗哌卡因40毫升 (200 mg) 浸润腹股沟,0.25% 罗哌卡因40毫升 (100 mg) 或生理盐水40毫升。
主要结果指标 : 休息和动员过程中的伤口疼痛,在3、6、10和24小时后施加压力达到疼痛阈值和最大疼痛耐受性,7天后; 服用镇痛药; 手术前后通过两个独立的问卷评估生活质量。
结果 : 在所有变量中,罗哌卡因组3小时后的疼痛评分均明显低于生理盐水组 (p <0.05)。6小时时,罗哌卡因0.5% 的疼痛评分明显低于动员期间伤口疼痛的生理盐水,并施加压力以达到最大疼痛耐受性。给予生理盐水的患者首次要求镇痛药的时间明显快于其他两组 (p <0.05),并且在最初的24小时内要求镇痛药的比例明显更高 (p <0.05)。生活质量问卷的评估显示,两组之间没有显着差异。
结论 : 罗哌卡因具有显着性,在术后即刻的剂量相关的减轻疼痛效果,但我们无法支持术前浸润镇痛可减轻长期疼痛的理论。

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