Interpleural Bupivacaine for Pain Relief after Transthoracic Endoscopic Sympathectomy for Primary Hyperhidrosis

肋膜間注射Bupivacaine對手汗症病患於接受經胸腔內視鏡交感神經切斷術後之止痛效果

柳復兆(Fuh-Jaw Lieou) ； 李世俊(Shih-Chun Lee) ； 何善台(Shung-Tai Ho) ； 王志中(Jhi-Joung Wang)

《Acta Anaesthesiologica Sinica》 34卷1期 (1996/03) Pp. 21-25

https://doi.org/10.6955/AAS.199603.0021

摘要

Background: Interpleural local anesthetic has been reported to provide good postoperative pain relief in patients receiving thoracotomy or upper abdominal surgery. However, there were few reports regarding interpleural local anesthetic for postoperative pain relief in patients receiving transthoracic endoscopic sympathectomy for palmar hyperhidrosis. The aim of the present study was to evaluate the effect of interpleural bupivacaine for postoperative pain relief in patients receiving transthoracic endoscopic sympathectomy for palmar hyperhidrosis. Methods: Sixty adult patients undergoing bilateral transthoracic endoscopic sympathectomy were randomly divided into two groups (n = 30, each group) for study. At the end of surgery, patients in group 1 were given bilaterally an injection of 0.5% interpleural bupivacaine (10 ml) through the surgical endoscope, whereas those in the group 2 who were not given any treatment at the juncture served as control. Postoperatively, intravenous morphine 2.5 mg was given luxuriously to the patients at their request at intervals of 30 min. The intensity of postoperative pain was assessed at rest and during cough with visual analogue scale (VAS, 0 - 10 points). Results: It was showed that at rest the pain scores were less in group I than in group 2 within 4 h postoperatively. During cough, group 1 also had less VAS scores than group 2 within 5 h postoperatively. Furthermore, patients in group 1 consumed less intravenous morphine than those in group 2 within 6 h postoperatively. Conclusions: Interpleural bupivacaine significantly decreased the intensity of postoperative pain and morphine consumption in patients undergoing transthoracic endoscopic sympathectomy for palmar hyperhidrosis. We are looking forward to seeing that with the addition of epinephrine to the anesthetic solution and a considerable increase of dosage and/or volume of bupivacaine may provide a better and longer pain relief, about which further studies are needed.

關鍵字

Analgesia: interpleural bupivacaine ； Autonomic denervation: transthoracic endoscopic sympathectomy ； Pain: postoperative

並列摘要

背景：在文獻中已指出局部麻醉劑於肋膜間使用可以有效治療開胸或開腹手術後疼痛。然而卻少有文獻探討此技術是否適用於緩解接受胸腔內視鏡交感神經切斷術之術後疼痛，本研究即針對此進行探討。方法：六十位接受雙側胸腔內視鏡交感神經切斷術之手汗症病患依隨機分為兩組。在手術結束前，第一組經內視鏡給予0.5％ bupivacaine 0.15 mg/kg，第二組則不給藥作為對照組。術後兩組皆接受靜脈注射嗎啡2.5 mg以緩解疼痛，其間隔至少為30分鐘。術後疼痛之程度則以視覺類比分數來記錄（0-10）。結果：在手術後4小時內，第一組病患休息時之疼痛分數較第二組低。在手術後5小時內，第一組病患咳嗽時之疼痛分數較第二組低，同時，在手術後6小時內第一組病患之嗎啡消耗量較第二組低。結論：對於經胸腔內視鏡交感神經切斷術之術後疼痛，肋膜間給予bupivacaine可以有效的治療。在將來，為了加強其止痛效果及延長療效，將可經加入血管收縮劑epinephrine，或增加bupivacaine之劑量及給藥體積來完成。

並列關鍵字

止痛：肋膜問bupivacaine ； 交感神經切除法：經胸腔交感神經切斷術 ； 疼痛：手術後