腹膜内用药在腹腔镜下胆囊切除术后镇痛中的应用

Application of intraperitoneal administration in the treatment of postoperative pain after laparoscopic cholecystectomy

腹腔镜胆囊切除术（Lc）术后呈轻至中度疼痛，临床上常规应用非甾体抗炎药（NSAIDS）、阿片类药物、抗癫痫药物等治疗术后疼痛。虽然这些药物起效快，但它们的不良反应，如嗜睡、术后恶心呕吐（PONV）、便秘以及呼吸抑制等可导致出院延迟。因此，许多学者研究LC术后镇痛的替代治疗方法。LC术后疼痛主要包括浅表切口痛，深部内脏痛和肩部牵涉痛三部分。药物种类有局部麻醉剂、类固醇、曲马多、右美托咪啶等。腹膜内应用药物的时间主要有三种：建立气腹前、建立气腹即刻以及胆囊摘除后。腹腔内应用药物常施于胆囊窝、肝脏膈面、肝膈间隙或肝十二指肠韧带附近等部位，应用的方法有滴注、浸润、喷洒和冲洗等。总之，多项研究已经证实腹膜内给药在LC术后早期有明显镇痛作用，可减少术后止痛药用量，并减轻相应的并发症。

Laparoscopic cholecystectomy （LC） patients showed mild to moderate pain, non steroidal anti-inflammatory drugs （NSAIDS）, opioids and antiepileptic drugs are used in routine treatment of postoperative pain in clinic. Although these drugs worked quickly, their adverse effects, such as drowsiness, post-operative nausea and vomiting （PONV）, constipation and respiratory inhibition can lead to delayed discharge. Therefore, many researchers study the replacement treatment of postoperative pain. Pain after LC can be divided into superficial incision pain, deep visceral pain and shoulder referred pain. The species of drug are local anesthetics, steroid, tramadol and dexmedetomidine. There are 3 main types intraperitoneal administration time： before the establishment of pneumoperitoneum, at the time of pneumoperitoneum and immediately after removal of the gallbladder. Intraperitoneal administration is often applied to the fossa of gallbladder, liver diaphragm, liver and diaphragm gap or the sites near the hepatoduodenal ligament. The main methods of intraperitoneal administration are instillation, infiltration, spraying and flushing. Based on many studies, it is beneficial to use intraperitoneal administration in terms of pain reduction in the early stage after LC. The use of intraperitoneal administration could reduce the amount of analgesic and mitigate the associated complications.