مقايسه تأثير بوپيواكائين داخل پريتونئال با پتيدين داخل وريدي بر ميزان درد بعد از عمل جراحي كله سيستكتومي لاپاراسكوپيك

Comparison of Intraperitoneal Bupivacaine and Intravenous Petidine on Postoperative Pain after Laparoscopic Cholecystectomy

زمينه و هدف با توجه به افزايش روزافزون اعمال جراحي لاپاروسكوپيك، استفاده از روش هاي مختلف كاهش درد پس از جراحي هاي لاپاراسكوپيك، بخصوص كله سيستكتومي لاپاراسكوپيك به عنوان يكي از شايعترين اعمال جراحي لاپاراسكوپيك، همواره محل بحث و اختلاف نظر بوده است. اين طرح با هدف مقايسه وضعيت بي دردي بعد از عمل جراحي كله سيستكتومي لاپاراسكوپيك با دو روش بوپيواكائين داخل پريتونئال با پتيدين داخل وريدي انجام شد. مواد و روش ها در يك مطالعه كارآزمايي باليني تصادفي شده دوسوكور، طي سال هاي 1385-1387 در بيمارستان شهيد مدرس تهران، تعداد 48 بيمار كانديد كله سيستكتومي لاپاروسكوپيك برحسب روش كاهش درد پس از جراحي به يكي از دو گروه مساوي استفاده از مخدر پتيدين بعد از عمل و گروه استفاده از داروي بي حسي بوپيواكائين داخل پريتونئال در انتهاي عمل تقسيم شدند.ﺟﻬﺖ ﺍﺭﺯﻳﺎﺑﻲ ﻳﮑﻨﻮﺍﺧﺘﻲ ﻭﺿﻌﻴﺖ ﺩﻭ ﮔﺮﻭﻩ ﻗﺒﻞ ﺍﺯ ﺷﺮﻭﻉ ﺩﺭﻣـﺎﻥ، ﻣﺘﻐﻴـﺮﻫﺎﻱ ﺩﻣﻮﮔـﺮﺍﻓﻴﮏ ﻣـﻮﺭﺩ ﻣﻘـﺎﻳﺴﻪ ﻗـﺮﺍﺭ ﮔﺮﻓﺘﻨﺪ ﻭ ﺟﻬﺖ ﺍﺭﺯﻳﺎﺑﻲ ﺗﺄﺛﻴـﺮ ﺩﻭ ﺭﻭﺵ ﻣﺘﻐﻴـﺮﻫﺎﻱ ﻣﻴـﺰﺍﻥ ﻧﻴـﺎﺯ ﺑﻪ ﻣﺴﻜﻦ ﺍﺿﺎﻓﻲ، ﻋـﻮﺍﺭﺿﻲ ﻣﺎﻧﻨـﺪ ﺗﻬـﻮﻉ ﻭ ﺍﺳﺘﻔـﺮﺍﻍ، ﻫﻴﭙﻮﺗﺎﻧﺴﻴـﻮﻥ ﻭ ﺩﭘﺮﺳﻴـﻮﻥ ﺗﻨﻔﺴﻲ ﻭ ﻧﻴـﺰ ﻣﻴـﺰﺍﻥ ﺗـﻮﺍﻥ ﺗﻨﻔﺴﻲ ﺩﺭ ﺩﻭ ﮔـﺮﻭﻩ ﺛﺒﺖ ﺷﺪﻧﺪ. ﻳﺎﻓﺘﻪ ﻫﺎ ﺑﺎ ﺍﺳﺘﻔـﺎﺩﻩ ﺍﺯ ﻧـﺮﻡ ﺍﻓـﺰﺍﺭ SPSS 13 ﻭ ﺁﺯﻣـﻮﻥ ﻫﺎﻱ ﺁﻣﺎﺭﻱ t- Test ﻭ Fisher's Exact Test ﻭ Multiple Mesures Test ﻣﻮﺭﺩ ﻭ ﺗﺤﻠﻴﻞ ﻗـﺮﺍﺭ ﮔﺮﻓﺘﻨﺪ ﻭ ﺑﻪ ﺻﻮﺭﺕ ﻣﻴﺎﻧﮕﻴﻦ ﺧﻄﺎﻱ ﺍﺳﺘـﺎﻧﺪﺍﺭﺩ ﺑﻴﺎﻥ ﮔﺮﺩﻳﺪﻩ ﺍﻧﺪ ﻭ P-value <0.05 ﻣﻌﻨﻲ ﺩﺍﺭ ﺩﺭ ﻧﻈﺮ ﮔﺮﻓﺘﻪ ﺷﺪ. ﻳﺎﻓﺘﻪ ﻫﺎ: ﺩﺭ ﻫﻴﭽﻜﺪﺍﻡ ﺍﺯﺑﻴﻤﺎﺭﺍﻥ ﺩﻭ ﮔﺮﻭﻩ، ﻫﻴﭙﻮﺗﺎﻧﺴﻴﻮﻥ ﻭ ﺩﭘﺮﺳﻴﻮﻥ ﺗﻨﻔﺴﻲ ﻣﺸﺎﻫﺪﻩ ﻧﺸﺪ. ﻣﻴﺰﺍﻥ ﻧﻴﺎﺯ ﺑﻪ ﻣﺴﻜﻦ ﺧﻮﺭﺍﻛﻲ ﭘﺲ ﺍﺯ ﺟﺮﺍﺣﻲ، ﺩﺭ ﮔﺮﻭﻩ ﺑﻮﭘﻴﻮﺍﻛﺎﺋﻴﻦ ﺩﺍﺧﻞ ﭘﺮﻳﺘﻮﻧﺌﺎﻝ ﺑﻪ ﻃﻮﺭ ﻣﻌﻨﻲ ﺩﺍﺭﻱ ﻛﻤﺘﺮ ﺍﺯ ﮔﺮﻭﻩ ﭘﺘﻴﺪﻳﻦ ﺩﺍﺧﻞ ﻭﺭﻳﺪﻱ ﺑﻮﺩ )0/003=P(. ﺗﻬـﻮﻉ ﻭ ﺍﺳﺘﻔـﺮﺍﻍ ﺩﺭ ﺳﺎﻋـﺖ ﻫﺎﻱ ﺍﻭﻟﻴـﻪ ﭘﺲ ﺍﺯ ﺟـﺮﺍﺣﻲ ﺩﺭ ﮔـﺮﻭﻩ ﺑﻮﭘﻴﻮﺍﻛﺎﺋﻴﻦ ﺩﺍﺧﻞ ﭘﺮﻳﺘـﻮﻧﺌﺎﻝ ﻛﻤﺘـﺮ ﺍﺯ ﮔـﺮﻭﻩ ﭘﺘﻴـﺪﻳﻦ ﺩﺍﺧﻞ ﻭﺭﻳﺪﻱ ﺑﻮﺩ )0/003 =P(. ﺗﻮﺍﻥ ﺗﻨﻔﺴﻲ ﺑﻴﻤﺎﺭﺍﻥ ﺩﺭ ﮔﺮﻭﻩ ﺑﻮﭘﻴـﻮﺍﻛﺎﺋﻴﻦ ﺩﺍﺧﻞ ﭘﺮﻳﺘـﻮﻧﺌﺎﻝ ﺑﻴﺸﺘﺮﺍﺯ ﮔـﺮﻭﻩ ﭘﺘﻴـﺪﻳﻦ ﺩﺍﺧـﻞ ﻭﺭﻳﺪﻱ ﺑﻮﺩ )0/006 =P( . ﻧﺘﻴﺠﻪ ﮔﻴـﺮﻱ: ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ ﺑﻮﭘﻴﻮﺍﻛﺎﺋﻴﻦ ﺩﺍﺧﻞ ﭘﺮﻳﺘﻮﻧﺌﺎﻝ ﺩﺭ ﺧﺎﺗﻤﻪ ﺟﺮﺍﺣﻲ ﻛﻠﻪ ﺳﻴﺴﺘﻜﺘﻮﻣﻲ ﻻﭘﺎﺭﺍﺳﻜﻮﭘﻴﻚ ﺑﺪﻟﻴﻞ ﺗﺄﺛﻴﺮ ﺑﻴﺸﺘﺮ ﺩﺭ ﻛﺎﻫﺶ ﺩﺭﺩ، ﺗﻬﻮﻉ ﻭ ﺍﺳﺘﻔﺮﺍﻍ

Introduction & Objective: The use of different techniques that reduce post operative pain after laparoscopic surgeries, especially laparoscopic cholecystectomy, as a one of the most prevalent laparoscopic surgeries, has been controversial. The aim of this project has been to compare the procedures of intraperitonal bupivacaine and intravenous petidine as far as pain after Laparoscopic Cholecystectomy is concenrned. Materials & Methods: In a randomized controlled trial at Modarres hospital's general surgery ward, 48 patients, who had enrolled for laparoscopic cholecystectomy, were divided in two groups. In 24 patients traditional method of intravenous petidine, was used at the end of laparoscopic cholecystectomy surgery, for reducing of post operative surgery pain and in 24 another patients, intraperitoneal injection of Bupivacaine was used at the end of surgery. The two groups were compared as far as the need for excessive analgesic, respiratory effort and some complications such as nausea and vomiting, hypotention, and respiratory depression was concerned. The data were analyzed by SPSS 13 and statistical t-test, Fisher's exact test and multiple measure test, and were expressed as mean standard deviation P