Author/Editor		Cesar-Komar, Marija; Vodopija, Nado; Zajec, Miha
Title		Multimodal compound analgesia after the laparoscopic cholecystectomy
Translated title		Sestavljena (modulirana) analgezija po endoskopsko odstranjenem žolčniku
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 68, št. 10
Publication year		1999
Volume		str. 549-54
Language		eng
Abstract		Background. The pain after the cholecystectomy is multifacctorial and as well somatic as visceral (1). The damage of tissues and cells is accompanied by released tissue pain mediators which sensitize or excite the nociceptors. The inflammation components also activate the cascadicpain transmission and pain modulation. The pneumoperitoneum also causes many pain impulses. The intense and very long lasting excitation causes alterations within the central nervous system, because of the plasticity of the nervous system with peripheral and central (hypersensitisation) hyperalgesia. The aim of our study is to achieve the multimodal, compound analgesia around (pre and postoperatively) the endoscopic cholecystectomy, with minimal side effects. It is a combination of infiltration of surgical ports with local anaestheticfor laparoscopic instruments before the surgery, and the infiltration of the bed of the cholecyst but after its removal by local anaesthetic (bupivacain) in a combination of continous infusion of minimal doses of the medium strong opioid analgesic tramadol after the operation. Materials and methods. The study was accepted by the Republic Medical Ethic Commission. The study design has been randomized, prospective, double blind case-control, with the use of the local anaesthetic (0,125% bupivacain) or placebo (0, 9% NaCl). In this study patients for the elective endoscopic cholecystectomy were included all from the surgical and urological department of the general hospital in Slovanj Gradec, in the period from April till December 1998. (Abstract truncated at 2000 characters.)
Summary		Izhodišča. Bolečina po odstranitvi žolčnika je somatska in visceralna. Poškodba tkiva in celic ima za posledico sproščanje bolečinskih mediatorjev, ki dražijo nociceptorje. Vnetna komponenta prav tako aktivira kaskadično bolečinsko dogajanje s prevajanjem in bolečinsko modulacijo. Intenzivno in zelo dolgo trajajoče draženje povzroča spremembe v centralnem živčnem sistemu, zaradi plastičnosti le-tega, kar ima za posledico periferno in centralno hipersenzitizacijo oz hiperalgezijo. Cilj naše študije je doseči dobro analgezijo po laparoskopski odstranitvi žolčnika in sicer multimodalno in sestavljeno iz različnih postopkov in analgetikov, z minimalntmi stranskimi efekti. Sestavljena je iz kombinacije splošne anestezije, infiltracije kirurških ran za laparoskopske inštrumente pred vstavitvijo le-teh in infiltracije ležišča žolčnika po njegovi odstranitvi. Po operaciji se terapija bolečine nadaljuje s kontinuirano infuzijo minimalnih doz srednje močnega opiatnega analgetika tramadola. Material in metode. Študijo je odobrila Etična komisija Republike Slovenije. Zasnovana je bila randomizirano, prospektivno, dvojno slepo, primer - kontrola, z uporabo lokalnega anestetika (0,125% bupivacain) ali placeba (0,9% NaCl). V študijo so bile vključene bolnice, predvidene za programsko - elektivno odstranitev žolčnika na urološkem in kiruršem oddelku Splošne bolnišnice Slovenj Gradec, v obdobju od aprila do decembra 1998. Zaradi razlik v občutenju in interpretiranju bolečin, med moškimi in ženskami, smo se odločili samo za ženske bolnice. (Izvleček prekinjen pri 2000 znakih.)
Descriptors		CHOLECYSTECTOMY, LAPAROSCOPIC ANESTHESIA PAIN, POSTOPERATIVE COMBINED MODALITY THERAPY ANESTHESIA, LOCAL ANALGESICS, OPIOID