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Intraperitoneal pethidine versus Intramuscular pethidine for the relief of pain after laparoscopic cholecystectomy: Randomized trial

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Abstract

Laparoscopic cholecystectomy is widely used and may be performed as an ambulatory procedure. We undertook a randomized comparison of the benefits of intraperitoneal pethidine compared with intramuscular pethidine for postoperative analgesia following laparoscopic cholecystectomy. A series of 100 consecutive American Society of Anesthesiologists (ASA) I or II patients were randomly assigned to intramuscular pethidine (54 patients) or intraperitoneal pethidine (46 patients). Each was combined with intraperitoneal bupivacaine. The primary end-points were the pain and nausea scores at intervals after operation. All recruited patients completed the study. Pain scores at rest and upon movement were significantly lower in the group receiving the intraperitoneal pethidine at each of the time periods examined (pain at rest at 4 hours: 1.6±0.8 vs. 2.4±0.9 cm; p<0.001; pain upon movement at 4 hours: 2.1±0.9 vs. 3.1±1.2 cm; p<0.001). The total dose of pethidine administered via patient-controlled analgesia (PCA) during the first 24 hours after surgery was also significantly lower in this group (total dose 50.9±3.9 vs. 55.9±4.4 mg; p<0.001). There were no significant differences in the respiratory rate at any of the time periods. Intraperitoneal pethidine analgesia was superior to an equivalent dose of intramuscular pethidine for the relief of postoperative pain in patients undergoing laparoscopic cholecystectomy. This was achieved at the expense of increased nausea but no significant increase in vomiting. The accessibility of this route of analgesia administration has implications for patients undergoing laparoscopic procedures, particularly with the recent trend toward increased use of ambulatory techniques.

Résumé

La cholécystectomie laparoscopique est réalisée dans le monde entier et peut être réalisée en ambulatoire. Nous avons comparé par une étude randomisée les bénéfices de la pethidine en intraperitoneal comparée à la pethidine en intramusculaire pour l’analgésie postcholecystectomic laparoscopique. Cent patients consécutifs, ASA I ou II, ont été randomisés pour recevoir soit de la pethidine en intra-musculaire (54 patients) ou en intrapéritonéale (46 patients). De la bupivacaïne a été administrée en intrapéritonéale chez tous les patients. Les critères de jugement principaux et secondaires ont été les scores de la douleur et de la nausée à des intervalles successifs post-opératoires. Tous les patients inclus ont complété l’étude. La douleur au repos et lors des mouvements a été significativement moindre dans le groupe recevant de la pethidine en intrapéritonéale à chaque intervalle étudié [douleur au repos à 4 heures: 1.6 (0.8) cm vs. 2.4 (0.9) cm; p=0.001; douleur lors des mouvements à 4 heures: 2.1 (0.9) cm vs. 3.1 (1.2) cm; p=0.001]. La dose totale de pethidine administrée via la PCA pendant les 24 premières heures après chirurgie a également été plus basse dans ce groupe [dose totale 50.9 (3.9) mg vs. 55.9 (4.4) mg; p=0.001]. Il n’y avait aucune différence statistiquement significative en ce qui concernait la fréquence respiratoire quel que soit le moment de l’étude. La pethidine en intrapéritonéale est supérieure à la pethidine en intramusculaire pour l’analgésie de la douleur post-cholécystectomie laparoscopique. Cette amélioration a été accomplie au prix de plus de nausées mais sans augmentation significative des vomissements. L’utilisation de cette route d’administration a des implications importantes chez le patient opéré sous laparoscopic, en particulier, vu la tendance actuelle à élargir les indications de la chirurgie ambulatoire.

Resumen

La colecistectomía laparoscópica es el procedimiento más empleado en cirugía ambulatoria. Efectuamos un estudio comparative aleatorio sobre los efectos, de la petidina intraperitoneal vs intramuscular, en la analgesia postcolecistectomía laparoscópica. 100 pacientes ASA I o II fueron aleatoriamente distribuidos en 2 grupos: petidina intramuscular (n=54) y petidina intraperitoneal (n=46); a este último grupo se le asoció bupivacaina intraperitoneal. Se investigaron el dolor y las nauseas durante el postoperatorio. Todos los pacientes completaron el estudio. El dolor postoperatorio tanto en reposo como con la movilización fue significativamente menor en el grupo de petidina intraperitoneal [dolor en reposo a las 4 horas 1.6 (0.8) cm vs 2.4 (0.9) cm; p<0.001; dolor a la movilización a las 4 horas 2.1 (0.9) cm vs 3.1 (1.2) cm; p<0.001]. Además, en este grupo la dosis total de petidina administrada en las primeras 24 horas del periodo postoperatorio fue menor [dosis total 50.9 (3.9) mg vs 55.9 (4.4) mg, p<0.001]. No se observaron diferencias significativas en la frecuencia respiratoria a lo largo del periodo postoperatorio. La analgesia proporcionada por la administración intraperitoneal de petidina es superior a la obtenida por inyección intramuscular, aunque se produzcan más nauseas pero sin que se incremente la frecuencia de vómitos. Dada la accesibilidad de esta vía para la administración de analgésicos este proceder debe tenerse muy en cuenta en las técnicas laparoscópicas, especialmente si se quiere incrementar la realización de las mismas de manera ambulatoria.

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Published Online: October 4, 2002

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O’Hanlon, D.M., Colbert, S., Ragheb, J. et al. Intraperitoneal pethidine versus Intramuscular pethidine for the relief of pain after laparoscopic cholecystectomy: Randomized trial. World J. Surg. 26, 1432–1436 (2002). https://doi.org/10.1007/s00268-002-6339-z

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