Author/Editor     Cesar-Komar, Marija
Title     Sestavljena (modulirana) analgezija po endoskopsko odstranjenem žolčniku
Translated title     Multimodal compound analgesia after the endoscopic cholecystectomy
Type     monografija
Place     Ljubljana
Publisher     Medicinska fakulteta
Publication year     1999
Volume     str. 47
Language     slo
Abstract     The pain after the cholecystectomy is as well somatic as visceral. The damage of tissues and cells is accompanied by released tissue pain mediators which sensitize or excite the nociceptors. The inflammation component also activates the cascadic pain transmission and modulation. The intense and very long lasting excitation causes the alterations within the central nervous system, described as the plasticy of the nervous system, or central (hypersensitisation) hyperalgesia. The aim of our study is the multimodal, compound analgesia after the endoscopic cholecystectomy. It is a combination of infiltration of surgical ports for laparoscopic instruments before the surgery and the infiltration into the bed of cholecyst after its removal with local anaesthetic bupivacain, and with minimum doses of the medium strong opioid analgesic tramadol in continous infusion. This mode of analgesia has proven to be very effective. Our study design has been randomized, prospective, double blind, with the use of the local anaesthetic (0,125 % bupivacain) or placebo (0,9% NaCl). After the operation patients have received minimum basal analgesia in continous intravenous infusion with tramadol in both groups. Already after the discharge from the hospital patients were classified into two groups, A and B, according to the infiltrated substance; in the group A was infiltrated local anesthetic and in the group B placebo was used. Each group consists of 10 patients of comparable weight, age and physical status. They were only female patients because of the sex differences in the pain perception. The success of this pain therapy was evaluated with the visual analogous scale (VAS) and with systemical indicators of pain, saturation, blood pressure and puls. These paramethers were observed and noticed at the patient's admittance to and the discharge from the recovery room, and another two days at the surgical ward as well.
Descriptors     CHOLECYSTECTOMY
SURGERY, ENDOSCOPIC
PAIN, POSTOPERATIVE
ANALGESIA
BUPIVACAINE
TRAMADOL
ANESTHESIA, LOCAL
PAIN MEASUREMENT
PIRINITRAMIDE
BLOOD PRESSURE
HEART RATE
ANESTHESIA RECOVERY PERIOD
QUESTIONNAIRES