|483||Local Infiltration with Ropivacaine Improves Immediate Postoperative Pain Control After Hemorrhoidal Surgery [2002년 1월 DCR]||2011-11-17||1966|
Be´atrice Vinson-Bonnet, M.D., Jean Claude Coltat, M.D.,† Abe Fingerhut, M.D.,Francis Bonnet, M.D
From the Department of Surgery and Department of Anesthesia, Centre Hospitalier Intercommunal Le´on
Touhladjian, Poissy, France, and ‡Department of Anesthesia and Intensive Care, Hoˆpital Tenon, Assistance Publique Hoˆpitaux de Paris, Paris, France
PURPOSE: This study was conducted to assess the efficacy of infiltration with a new local anesthetic (ropivacaine) to control pain after hemorrhoidal surgery.
METHODS: Thirtyfour patients who underwent hemorrhoidectomy were included in a double-blind, randomized study to assess the analgesic effect of a perianal infiltration with 40 ml of 0.75 percent ropivacaine compared with isotonic saline infiltration. Postoperatively, pain was assessed on a visual analog scale, and intravenous morphine consumption was measured with patient-controlled administration.
RESULTS: In the ropivacaine group, patients had lower visual analog scale scores at 1, 3, and 6 hours after infiltration and required fewer cumulative doses of morphine (patient-controlled administration) at 3, 6, and 12 hours. Side effects were comparable in the two groups.
CONCLUSION: Local infiltration with ropivacaine improves pain control and patient comfort in the immediate postoperative course of hemorrhoidal surgery.
The postoperative course of hemorrhoidal surgery is commonly extremely painful, justifying the
administration of substantial amounts of analgesics such as opioids, which may produce nausea and
vomiting, increase urinary retention, and decrease bowel motility. Incisional infiltration with local anesthetics has been documented to improve postoperative pain control after inguinal hernia repair or laparoscopic cholecystectomy. Infiltration with local anesthetics may also participate in providing adequate pain control after hemorrhoidal surgery. Ropivacaine is a long-acting local anesthetic that is less cardiotoxic than bupivacaine, which is also commonly used to produce long-lasting anesthesia and analgesia. Because a high vascular absorption is supposed to occur after perineal infiltration with local anesthetics, ropivacaine may thus guarantee a good safety margin between effective and toxic doses. We therefore designed a prospective, double-blind, randomized study to assess the effect of local infiltration with ropivacaine on postoperative pain after hemorrhoidal surgery.