帕瑞昔布钠联合罗哌卡因对腹腔镜胆囊切除术后疼痛的影响

摘要

目的 探讨帕瑞昔布钠联合罗哌卡因用于腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)后疼痛的镇痛效果. 方法 2012年1～8月择期LC 60例,随机分为帕瑞昔布钠联合罗哌卡因组(简称联合组)和对照组.联合组患者在手术开始前静脉注射帕瑞昔布钠40 mg,并于气腹结束前,向膈下喷洒0.2％罗哌卡因10 ml,缝合腹壁切口前,向每个切口局部注入相同局麻药液5 ml.对照组给予同等剂量生理盐水.记录术后2、4、8、12、24 h VAS评分、镇痛药用量及副反应发生情况. 结果 联合组术后2、4、8、12、24 h VAS评分分别为(2.8±0.3)、(2.8±0.4)、(2.4±0.7)、(1.7±0.3)、(1.4±0.5)分,显著低于对照组相应时点(7.1±1.1)、(6.3±0.7)、(5.2±0.6)、(3.5±0.5)、(1.7±0.5)分(t=20.657,P=0.000;t=23.778,P=0.000;t=16.634,P=0.000;t=16.908,P=0.000;t =2.324,P=0.000).联合组24 h镇痛药物需求4例(13.3％)显著少于对照组28例(93.3％,x2=38.571,P=0.000). 结论 帕瑞昔布钠联合罗哌卡因对LC术后镇痛效果良好,可显著减少术后镇痛药用量.%To investigate the effects of parecoxib sodium preemptive analgesia and Intraperitoneal injection of ropivacaine on postoperative visceral pain in patients undergone laparoscopic cholecystectomy ( LC). Methods Totally 60 patients were randomly divided into two groups: control group received sodium chloride injection, and experimental group received parecoxib and ropivacaine. In the experimental group, parecoxib (40 mg) was injected intravenously before LC , and 0. 2% ropivacaine (10 ml) was sprayed beneath diaphragm before the end of pneumoperitoneum. A same local anesthetics (5 ml) was injected at each incision before it was closed (control group received physiological saline at a same dosage). The postoperative usage of analgesics and adverse effects were observed and VAS was evaluated at 2, 4, 8, 12, and 24 hours after the procedure. Results In the experimental group, the VAS was 2.8 ±0. 3, 2. 8 ±0. 4, 2. 4 ± 0. 7, 1. 7 ±0. 3, and 1. 4 ±0. 5 at 2, 4, 8, 12, and 24 hours, which were significantly lower than those in the control (7. 1 ±1. 1 , 6.3 ±0.7, 5.2 ±0.6, 3.5 ±0.5, and 1.7 ±0.5; t =20.657, P =0.000; t=23.778, P = 0.000; t = 16.634, P = 0.000; t = 16.908, P =0.000; and t =2.324, P =0.000, respectively). At 24 hours, 4 patients in the experimental group asked for analgesics ( 13. 3% ) , which was significantly less than that in the control (28 cases, 93. 3% , x2 =38.571 , P =0.000). Conclusion Preemptive parecoxib combined with intraperitoneal injection of ropivacaine can produce better analgesia effect and fewer adverse effect.