복강경 질식 자궁 적출술시 양측 자궁천골인대부위 로피바케인 주입의 수술 후 진통효과 분석

Abstract

Background: Although laparoscopic hysterectomy, a world popular technical method, ensures faster recovery and less post-operative pain rather than laparotomic hysterectomy, immediate postoperative pain control has been still required to improve a quality of postoperative care. We introduce an effective method, intraoperative injection of ropivacaine into both of uterosacral ligaments to control immediate postoperative pain. Materials and Methods: We performed a prospective, double-blind, and randomized study. We analyzed 40 cases of laparoscopic vaginal hysterectomy performed between July 2015 and November 2016, by a single surgeon (Y.S.Kwon). Enrolled patients were randomized into the ropivacaine injection group and the saline injection group. Before closure of the abdominal wall, 7.5% ropivacaine (5mL) or saline (5mL) was administered into both of uterosacral ligament. The primary outcomes included the post-operative pain intensity expressed by Numeric Ranking Scale (NRS) values at 2, 6, 12 and 24 hours after injection. The secondary outcomes included the amount of analgesics demanded for pain control during 24 hours after the surgery. Results: The pain intensity at 2 hours after injection was significantly lower in the ropivacaine injected group (p=.0234). There was no difference in pain intensity at 6, 12, and 24 hours after injection and the amount of analgesics used. However, the total amount of used opioid analgesic was lower in the ropivacaine injected group, as compared to the placebo injected group. (p=.0251). Conclusion: Intraoperative ropivacaine injection into both of uterosacral ligament during laparoscopic hysterectomy can reduce early post-operative pain and consumption of analgesics to improve a quality of postoperative care.