| BACKGROUNDThe laparoscopic procedures ,which usually cause less trauma than traditionl small-incision &open procedures,have been used widly in a varies of general surgery areas since the fisrt laparoscopic cholecystectomy(LC) was performed successfully by Mouret in 1987. Although laparoscopic cholecystectomy results in less pain than open cholecystectomy(OC), it is not a pain-free procedure. Early postoperative pain or considerable discomfort is the most common complaint from patients after elective LC. About 30%-73% of LC patients require opioid treatment postoperatively that can account for the reason of discharge delay. Recent investigations show that there are three types of postoperative pain associared with LC, including incisional, visceral and referred shouder pain, which are considerably different from the pain profile seen after OC. Many methods of analgesia used alone for pain relief ,such as applying wound long-acting local anesthetic,replacement of insufflation gas or Non-steromdal anti-inflammatory drugs ,have been evaluated and showedconflicting results.Up to now ,there is no study reported the effects of pre-emptive analgesia of combining ropivacaine with Lornoxicon for patients undergoing LC. MATERIALS AND METHODSForty-five ASA I - II patients undergoing laparoscopic cholecystectomy were randomly allocated into one of the three blinded treatment groups: Group A received local infiltration of 10ml 0.25% ropivacaine at the surgical site before incision while 8mg Lornoxicam was given intravenously before anesthesia induction. Group B received an equal volume of 0.25% bupivacaine and Lornoxicam after trocar removal. In addition, intraperitoneal spray with 50ml 0.25% ropivacaine were given before and after creation of pneumoperitoneum in group A and group B Respectively. In group C , which served as central group, equal amount of nomal saline was used as a placebo after laparoscopy. Postoperatively, the pain score of the patients was evaluated by the Visual Analogue Scale (VAS) at 1,2,3,6,8,12,24hr after surgery.Analgesic medication consumption ,side effects such as nausea and vomitting were compared among the three groups. Blood concentrations of glucose, interleukin-6(IL-6)and cortisol were also measured in both pre and postoperative period (0,2,24hrs after operation). RESULT1 .Postoperative total pain scores (IPS) was significantly less in the group A than group B and contra! group(P< 0. 05). VAS in group A at l,3,6,24h was 2.7+ 0.6,3.2+0.7,3.5+0.9,2.8+0.3 and in group B was 3.6+0.9,3.6+0.6,3.4+0.4,3.1 +1.3 and in group C 4.1+0.7,4.4+0.5,4.4+0.6,3.1+0.2 respectively. 2.There were significant difference in pain scores of three types of components .Approximately 13.4% of shoulder-tip pain was observed in group A.Incisional pain scores in group A were significantly lower 24 hrs following surgerythan group B and C(P< 0. 05). Compared with group C, visceral pain scores ingroupA were significantly lower at 2,3,12hrs after surgery(P< 0. 05). 3.Postoperative analgesic requirements were also significantly reduced in group Athan group B and group C(P< 0. 05) 4.Blood sugar level was increased after LC, peak values in group C at 2 h afteroperation. Blood sugar were significantly different between group A and group C(p<0.05),there was no significant difference between group B and C(P>0. 05). 5.Plasma levels level of cortisol in both group B and C were significanty increasedafter LC (p<0.05), At 2hr postoperatively, the levels of cortisol reached peak valuein group C. Plasma level of cortisol in groupC was significantly higher than that ingroup A at Omin,2hr after LC (P<0.05). 6.Plasma levels of IL-6 in both group B and C were significanty increased after LC ,Plasma level of IL-6 in groupC was significantly higher than that in group A atOmin postoperatively (P<0.05). CONCLUSION 1.The preemptive analgesia of combining intravenous Lomoxicam with lowconcentration ropivacaine for wound infiltration& intraperitoneal spray couldpro...
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