Abstract
Purpose
Peritoneal inflammation is an important feature in many patients presenting with appendicitis. The contribution of peritoneal nerve fibres to pain experienced after appendicectomy has received little attention.
Method
In this prospective double blind randomized study a consecutive series of 60 patients undergoing appendicectomy for suspected appendicitis were enrolled. A dose of 1.5 mg·kg−1 bupivacaine 0.5 % was used. Group one patients received the entire dose of bupivacaine subcutaneously. Group two patients received half the dose subcutaneously (sc) and half the dose to the peritoneum. Pain scores were assessed pre-operatively and at 30 min, 12 and 24 hr post-operatively using a visual analogue scale. Time to first analgesia and total analgesia requirements in the first 24 hr were recorded.
Results
The patients receiving the sc combined with peritoneal bupivacaine had a lower pain score 30 min postoperatively (32 ± 2 vs 54 ± 4;P < 0.0001), a longer time to first analgesia (248 ± 20 vs 164 ± 17 min; P = 0.002)as well as lower opioid (68 ± 5 vs 100 ± 7 mg; P = 0.0002) and non steroidal analgesic requirements (65 ± 6 vs 96 ± 6 mg; P = 0.007) in the first 24 hr post-operatively.
Conclusion
A combination of sc and peritoneal infiltration with bupivacaine is superior to skin infiltration alone in the relief of pain post appendicectomy.
Résumé
Objectif
Linflammation péritonéale est un signe important chez de nombreux patients souffrant d’une appendicite. La participation des fibres nerveuses du péritoine à la douleur éprouvée après l’appendicectomie n’a jamais vraiment retenu l’attention.
Méthode
Une série de 60 patients consécutifs suspects d’appendicite et devant subir une appendicectomie ont été inclus dans une étude prospective, en double insu et randomisée. Une dose de 1,5 mg·kg−1 de bupivacaïne 0,5 % a été utilisée. Les patients du premier groupe ont reçu la dose complète en infiltration sous-cutanée. Ceux du deuxième groupe ont reçu la moitié de la dose en infiltration sous-cutanée (sc) et le reste en infiltration péritonéale. Les niveaux de douleur ont été évalués avant l’intervention, puis 30 min., 12 et 24 h après l’intervention, d’après une échelle visuelle analogue. Le moment où a eu lieu la première analgésie et les besoins totaux d’analgésie pendant les 24 premières heures ont été enregistrés.
Résultats
Les patients qui ont reçu une combinaison d’infiltration sc et péritonéale de bupivacaïne ont présenté un niveau de douleur plus bas 30 min après l’intervention (32 ± 2 vs 54 ± 4;P < 0,0001), ont eu besoin d’une première analgésie plus tard que ceux de l’autre groupe (248 ± 20 vs 164 ± 17 min; P = 0,002), d’une plus faible quantité d’opioïde (68 ± 5 vs 100 ± 7 mg; P = 0,0002) et d’analgésique non stéroïdien (65 ± 6 vs 96 ± 6 mg; P = 0,007) pendant les 24 premières heures postopératoires.
Conclusion
Une combinaison d’infiltration sc et péritonéale de bupivacaïne est supérieure à l’infiltration cutanée employée seule pour soulager la douleur ressentie après l’appendicectomie.
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Colbert, S., O’Hanlon, D.M., Courtney, D.F. et al. Analgesia following appendicectomy — the value of peritoneal bupi-vacaine. Can J Anaesth 45, 729–734 (1998). https://doi.org/10.1007/BF03012142
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DOI: https://doi.org/10.1007/BF03012142