تأثیر انفیلتراسیون موضعی دو دوز هیدروکورتیزون به‌صورت پره امپتیو بر درد و تهوع و استفراغ بعد از عمل جراحی کوله سیستکتومی تحت لاپاراسکوپی

نوع مقاله : Original Article(s)

نویسندگان

1 استاد، گروه بیهوشی و مراقبت‌های ویژه، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

2 دانشیار، گروه جراحی، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

3 دانشکده‌ی پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

10.48305/jims.v43.i831.1124

چکیده

مقاله پژوهشی




مقدمه: کوله‌سیستکتومی لاپاراسکوپیک پروسیجر انتخابی برای درمان کوله‌سیستیت است. شدت درد حاصل از این جراحی برای بسیاری از بیماران غیرقابل تحمل است و مطالعه برای مقایسه‌ی تأثیر دو دوز هیدروکورتیزون به صورت پره امپتیو بر درد و تهوع انجام شد.
روش‌ها: این مطالعه‌ی کارآزمایی بالینی، به‌صورت سه سوکور روی بیماران بیمارستان الزهرای اصفهان که به علت کوله‌سیستیت تحت عمل کوله‌سیستکتومی لاپاراسکوپیک قرار گرفتند انجام شد. نمونه‌گیری غیرتصادفی و تخصیص گروهی به‌روش رندوم الوکاسیون انجام شد. بیماران به سه گروه mg 100  Aهیدروکورتیزون، گروه mg 50 B هیدروکورتیزون و گروه cc 20  Cاز نرمال‌سالین بدون دارو تقسیم شدند. شدت درد و شدت تهوع با مقیاس عددی VAS در ریکاوری و تا 24 ساعت پس از عمل اندازه‌گیری شد. داده‌ها با آزمون ANOVA و اندازه‌های مکرر تحلیل شد.
یافته‌ها: میزان درد به صورت معنی‌دار در گروه mg 100 هیدروکورتیزون کمتر از گروه mg 50 هیدروکورتیزون و کمتر از گروه کنترل بود (0/003 = P) و متوسط مقدارضد درد دریافتی به‌صورت معنی‌دار در گروه کنترل بیش از گروه mg 50 هیدروکورتیزون و بیش از گروه mg 100 هیدروکورتیزون بود (0/001 > P) و میانگین اولین زمان نیاز به ضد درد در گروه کنترل کمتر از گروه mg50 هیدروکورتیزون و کمتر از گروه mg 100 هیدروکورتیزون بود (0/001 > P). شدت تهوع (0/40 = P) فراوانی بروز استفراغ (0/06 = P) و تعداد دوز ضد تهوع دریافتی (0/06 = P) و میانگین اولین زمان نیاز به ضد تهوع (0/09 = P) بین سه گروه تفاوت معنی‌داری نداشت.
نتیجه‌گیری: انفیلتراسیون موضعی دو دوز هیدروکورتیزون به‌صورت پره امپتیو بعد از عمل جراحی کوله‌سیستکتومی تحت لاپاراسکوپی تأثیرات مطلوبی بر درد پس از جراحی داشت و بر تهوع و استفراغ پس از جراحی تأثیری نداشت.

تازه های تحقیق

محمدرضا صفوی: Google Scholar 

عظیم هنرمند: Google Scholar 

مسعود صیادی شهرکی: Google Scholar 

کلیدواژه‌ها

موضوعات

عنوان مقاله [English]

A Comparative Study of the Effect of Local Infiltration of Hydrocortisone Dose Preemptively on Pain and Nausea and Vomiting after Laparoscopic Cholecystectomy Surgery

نویسندگان [English]

  • Seyed Mohammad Reza Safavi 1
  • Azim Honarmand 1
  • Masood Sayadishahraki 2
  • Parto Derakhshandeh 3
1 Professor, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
2 Associated Professor of Surgery, Isfahan University of Medical Sciences, Isfahan, Iran
3 Isfahan University of Medical Sciences, Isfahan, Iran
چکیده [English]

Background: Laparoscopic cholecystectomy, while minimally invasive, often results in significant pain during the first 24 hours postoperatively. This study aimed to compare the preemptive local infiltration of two different doses of hydrocortisone on pain and postoperative nausea and vomiting (PONV) following this procedure.
Methods: In a triple-blind clinical trial conducted between 2021 and 2022, patients undergoing elective laparoscopic cholecystectomy at Isfahan Al-Zahra Hospital were randomly assigned to three groups: Group A received 100 mg hydrocortisone, Group B received 50 mg hydrocortisone, and Group C received 20 mL normal saline as a placebo. Pain and nausea intensity were assessed using a Visual Analog Scale (VAS) in the recovery room and for 24 hours post-surgery.
Findings: Pain intensity was significantly lower in the 100 mg hydrocortisone group compared to both the 50 mg group and the control group (P = 0.003). The control group required significantly more analgesic medication than both hydrocortisone groups (P < 0.001) and had a shorter time to first analgesic request (P < 0.001). However, no significant differences were observed among the three groups in terms of nausea severity (P = 0.40), vomiting frequency (P = 0.06), number of antiemetic doses (P = 0.06), or time to first antiemetic need (P = 0.09).
Conclusion: Preemptive local infiltration of hydrocortisone, particularly at a 100 mg dose, effectively reduces postoperative pain and analgesic requirements in patients undergoing laparoscopic cholecystectomy but does not significantly affect the incidence or severity of PONV.

کلیدواژه‌ها [English]

  • Laparoscopic cholecystectomy
  • Hydrocortisone
  • Pain
  • Nausea
  • Vomiting

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مجله دانشکده پزشکی اصفهان
دوره 43، شماره 831
هفته 3، آبان
مهر و آبان 1404
صفحه 1124-1132

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سابقه مقاله

  • تاریخ دریافت: 24 اردیبهشت 1404
  • تاریخ پذیرش: 28 تیر 1404

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