腹腔镜胆囊切除术后局部应用罗哌卡因的镇痛效果观察

摘要

Objective To investigate the postoperative analgesic effect of Ropivacaine by preoperative local infiltration through cuts and intraoperative topical anesthesia in abdominal cavity for patients undergoing laparoscopic cholecystectomy. Methods Sixty patients underwent laparoscopic cholecystectomy under general anesthesia were randomly divided into 2 groups (30 cases for each group). In group A,0. 5% Ropivacaine Hydrochloride 4 ml was injected before skin incision through umbilical incision,xiphoid incision and subcostal incision,and before the end of the operation,0. 5% Ropivacaine Hydrochloride 20 ml was nebulized in abdominal cavity. No management was performed in group B. The same induction and maintenance of anesthesia I. V. Combined with laryngeal mask airway were performed in both two groups. Non-invasive blood pressure, electrocardiogram, respiration, pulse, oxygen saturation were continuously monitored after operation. Visual analogue scale ( VAS) scores at 2,4,8,12 and 24 hours after operation. Postoperative use and side effects of additional analgesic drugs were recorded. Results At4,8,12 hours after operation, the postoperative analgesic effect in group A was better than that of group B ( P < 0. 05 ) . The frequency of additional use of analgesic drugs in group A was less than that in group B ( P < 0. 05 ) . And there were no significant differences between the two groups in incidence rates of adverse effects, such as nausea, vomiting, skin itch and respiratory depression (P > 0.05). Conclusion Ropivacaine by preoperatively local infiltration through cuts and intraoperatively topical anesthesia in abdominal cavity can get satisfied postoperative analgesic effect for patients undergoing laparoscopic cholecystectomy.%目的 探讨罗哌卡因术前切口局部浸润和术中腹腔内表面麻醉对腹腔镜胆囊切除术患者术后镇痛的效果.方法 选择择期全麻下行腹腔镜胆囊切除手术患者60例,按随机数字表法分为A、B组各30例,A组切皮前脐部切口及剑突下、肋缘下切口各注入0.5％盐酸罗哌卡因4 ml,手术结束前腹腔内喷洒0.5％盐酸罗哌卡因20 ml;B组不做任何处理.两组麻醉诱导、维持方法相同,均采用全凭静脉麻醉联合喉罩气道管理,术后持续监测无创血压、心电图、呼吸、脉搏血氧饱和度.记录术后2、4、8、12、24小时的疼痛视觉模拟(visual analogue scale,VAS)评分和术后额外镇痛药使用情况及不良反应发生情况.结果 A组术后4、8、12小时镇痛效果优于B组(P＜0.05),额外镇痛药使用次数少于B组(P＜0.05)；两组恶心、呕吐、皮肤瘙痒及呼吸抑制情况比较,差异均无统计学意义(P＞0.05).结论 罗哌卡因术前切口局部浸润和术中腹腔内表面麻醉对腹腔镜胆囊切除术患者具有很好的镇痛效果.