| Background Laparoscopic surgical procedures have been the most popular operation in gynecologic surgery,because of the small incision,less trauma,fewer complications and excellent recuperation.ERAS use a series of measures to promote postoperative recovery in minimally invasive surgery,they include reduce postoperative pain and facilitate the recovery of intestinal function for surgical patients.Multimodal analgesia is the major method of intraoperative pain management,it is based on the concurrent use of primarily non-opioid analgesics and techniques to minimize opioid use and opioid-related adverse effects.Flurbiprofen axetil,a nonsteroidal anti-inflammatory agents,is a non-opioid agent used in multimodal analgesia and it's proven to be effective.There has been reported that using intravenous lidocaine is effective in abdominal operations.Intravenous lidocaine in the perioperative period results in less postoperative pain and opioid consumption,earlier return of gastrointestinal tract function,and decrease postoperative nausea and vomiting.But other reports suggested that the intravenous lidocaine didn't has these benefits.Purpose This study aims to compare the effect of flurbiprofen axetil and lidocaine on postoperative pain,complications and recovery following laparoscopic gynaecological surgeries when employed perioperatively.Methods In a double-blind,randomized controlled trial,77 women undergoing laparoscopic gynecological surgery with general anesthesia were studied.Patients in the FA group received 1 mg/kg of IV flubiprofen axetil 10 min administrated preanesthesia,while the LD group received 1.5 mg/kg of IV lidocaine before surgical incision and followed by an infusion of lidocaine at a rate of 1.5 mg?kg-1?h-11 during the surgery.Pain was assessed using the visual analog scale?VAS?at 0,2,4,6,8,12,and 24h postoperatively.The postoperative analgesia was performed with 100mg flubiprofen axetil when the score of VAS?4,if the score of VAS still higher than 4 we will continue to give dezocine to alleviate pain.We will evaluate Ramsay sedation score?Ramsay?on 2h postoperatively.Total flubiprofen axetil consumption,total opioid consumption,the ratio of side effects,intraoperative inhalation concentration of sevofluran,the time of first flatus and first defecation were recorded.Results Basic demographic characteristics such as age,BMI,grade of ASA and time of operation did not differ significantly between the two group.There have significant differences in analgesic requirement and opioid consumption between groups?P<0.05?.The flubiprofen axetil consumption was?107.1?67.5?mg in the FA group higher than?73.4?53.8?mg in the LD group?P<0.05?.The Remifentanil consumption was?463.4?185.8??g in the FA group and?218.9?92.2??g in the LD group?P<0.05?.Inhaled sevoflurane concentration were lower significantly in the LD group than FA group during operation?P<0.05?.The time to first flatus was?20.8?9.7?h in the FA group and?17.4?9.6?h in the LD group?P=0.12?.The time to first defecation was?43.5?18.7h?in the LD group which shorter than?52.8?20.3?h in the FA group?P=0.04?.There were no significant differences in VAS pain score between both groups except at 4h?P<0.05?,LD group is lower than FA group,in resting score is[LD group?1.6?1.1?vs FA group?2.4?1.1?]and activity score is[LD group?2.1?1.1?vs FA group?3.0?1.4?].There were neither significant differences in Ramsay scores between groups?P>0.05?.The incidence of postoperative adverse reaction in terms of abdominal distension,nausea and vomiting did not differ statistically significant differences?P>0.05?.Conclusion IV lidocaine can reduce post-operative pain following laparoscopic gynecological surgery,along with decrease quantity of inhaled sevoflurane along with decrease opioid consumption and promote recovery of intestinal function. |
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