| BackgroundsLaparotomy surgery is one of the most painful types of surgery.The incidence of moderate and severe acute pain is as high as 60-80%,and the incidence of chronic pain within 3-6 months was 15-40%.Among many factors that lead to acute and chronic postoperative pain,wound pain caused by skin and abdominal wall injury caused by the operation are the main source of postoperative pain for patients with laparotomy.The skin traction stimulation caused by respiratory movement and daily activities of patients after surgery will further aggravate the degree of wound pain,resulting in restlessness,insomnia and even serious complications such as wound tear and infection.In order to decrease the length of stay and economic burden,improve the quality of life and satisfaction of patients during the perioperative period,it is crucial to explore the effective postoperative wound analgesia.Local wound infiltration(LWI)is a kind of analgesic method that injects local anesthetics and/or other drugs into the incision site.It can block the conduction of pain signals in the incision site,effectively reduce the occurrence of adverse reactions caused by systemic medication and produce an effective analgesic effect.However,LWI has some shortcomings,such as short analgesia time,controversial analgesic effect and safety,etc.It should be noted that safe and effective adjuvants are of great significance for further improving the LWI effect and developing long-term local anesthetics.Compared with other adjuvants,opioids and nonsteroidal anti-inflammatory drugs are characterized by analgesia.It is not clear that whether the analgesic effect,the acceleration of gastrointestinal function recovery and the safety of Nalbuphine and Ketorolac as representative drugs for LWI on postoperative acute and chronic pain of large incision surgery such as open colorectal surgery are obvious.ObjectiveTo compare and evaluate the efficacy of Nalbuphine and Ketorolac tromethamine as LWI adjuvants in acute and chronic postoperative pain,gastrointestinal function recovery and safety.MethodsFrom June 2018 to March 2019,124 adult patients(58 males and 66 females)were selected to undergo open colorectal surgery under general anesthesia.All patients included in this study were screened in strict accordance with the inclusion and exclusion criteria.The patients were randomly divided into three groups: Ropivacaine group(Group C,41 cases),Nalbuphine + ropivacaine group(group N,42 cases),Ketorolac + ropivacaine group(group T,42 cases).Before skin closure,LWI was performed by the same group of surgeons who did not participate in the study(1 ml of medicine was injected per 1 cm of incision length for each incision).When the analgesic effect was not satisfied [Numeric rating scales(NRS)scores?4],the rescue analgesic measures were used(intramuscular injection morphine 5 mg);patients with nausea and vomiting were given tropisetron.The following indexes were observed and recorded:(1)general information of height,age,gender,etc.;(2)time of first pressing analgesia pump and rate of rescue analgesia after surgery;(3)NRS scores of resting and coughing at 2h,4h,8h,12 h,24h,48 h and 72 h postoperatively;(4)chronic pain at 3 months after operation;(5)recovery of gastrointestinal function: first flatus time,first stool time,time of normal diet and the length of hospital stay;(6)the independent risk factors of chronic pain were analyzed;(7)the incidence of adverse reactions(such as nausea and vomiting,local anesthetic toxicity)and postoperative wound healing.ResultsCompared with T group and N group,the time to first pressing analgesia pump was significantly shorter(P < 0.05)in group C;In group C,NRS scores of 4,8,12 and 24 hours after surgery(no matter in resting or coughing),rescue analgesia rate on the first day after surgery,degree and incidence of chronic postsurgical pain(CPSP)in 3 months,first flatus time,first stool time,the length of hospital stay and the incidence of postoperative nausea and vomiting were significantly higher(P< 0.05).Compared with group N,the degree and incidence of chronic pain in group T were significantly lower in 3 months after surgery(P< 0.05).However,the other results showed no significant difference between group N and group T(P> 0.05).Additionally,there was no statistically significant difference between the three groups in NRS score at 2h,48 h and 72h(either in resting state or cough)and the time to normal diet(P> 0.05).During the observation period,only a few patients in the three groups had adverse reactions such as hypotension(P>0.05),no local anesthetic toxicity and wound infection and suppuration were recorded.Multiple logistic regression analysis showed that women,smoking,no adjuvants and NRS score?4 at 24 hours after surgery were the independent risk factors of CPSP in patients with colorectal surgery.The accuracy of the model was 93.3%,with high sensitivity(78.3%)and specificity(90.6%).Conclusions(1)In open colorectal surgery,Ketorolac and Nalbuphine,as LWI adjuvants,have good effects in prolonging the time of analgesia,alleviating the acute pain 48 hours after surgery,reducing the number of rescue analgesia and promoting the recovery of gastrointestinal function;(2)Compared with no adjuvant,Ketorolac or Nalbuphine can reduce the incidence of chronic pain 3 months after surgery;Ketorolac as LWI adjuvant had a better inhibition effect on chronic pain,but this result needs to be interpreted carefully;(3)Poor postoperative acute pain controlled,women and smoking may be independent risk factors for CPSP in three months;(4)In open colorectal surgery,LWI could not cause wound infection by strictly following aseptic principle. |
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