摘要
目的评价罗哌卡因复合布托啡诺腹横肌平面(transversus abdominis plane,TAP)阻滞对妇科腹腔镜手术患者术后镇痛及早期康复的影响。方法择期全麻下行妇科腹腔镜手术患者60例,年龄18~65岁,体重50~76 kg,ASAⅠ或Ⅱ级,采用随机数字表法将患者随机分为两组:罗哌卡因复合布托啡诺组(BR组)和罗哌卡因组(R组),每组30例。所有患者在麻醉诱导后均行双侧TAP阻滞。BR组患者每侧注入0.375%罗哌卡因20 ml+0.1%布托啡诺1 ml,R组患者每侧注入0.375%罗哌卡因20 ml+生理盐水1 ml。记录患者术中丙泊酚及瑞芬太尼用量、术后2、24 h的VAS疼痛评分、术后肠道功能恢复时间、下床活动时间、术后24 h的40项恢复质量(quality of recovery,QoR-40)评分。记录TAP阻滞有关不良反应和术后恶心呕吐的发生情况。结果与R组比较,BR组术中瑞芬太尼用量明显减少(P<0.05),术后2 h的VAS疼痛评分明显降低(P<0.05),术后24 h的QoR-40评分明显升高(P<0.05)。两组术中丙泊酚用量、术后肠道功能恢复时间、下床活动时间、术后恶心呕吐发生率差异无统计学意义。两组均无一例TAP阻滞有关不良反应发生。结论罗哌卡因复合布托啡诺用于腹横肌平面阻滞可减少术中瑞芬太尼用量,改善术后疼痛,提高患者术后麻醉恢复质量。
Objective To evaluate the effect of butorphanol combined with ropivacaine in transversus abdominis plane(TAP)block for postoperative analgesia and early rehabilitation following gynecological laparoscopy.Methods Sixty patients scheduled for elective gynecological laparoscopy under general anesthesia,aged 18-65 years,weighing 50-76 kg,falling into ASA physical statusⅠorⅡ,were randomly divided into two groups by using random number table method:TAP block either with 0.375%ropivacaine 20 ml and 0.1%butorphanol 1 ml(group BR,n=30)or 0.375%ropivacaine 20 ml and normal saline 1 ml(group R,n=30).After anesthetic induction,all the patients were performed bilateral TAP block.The intraoperative consumption of propofol and remifentanil,the VAS scores 2 and 24 h after operation,the recovery time of postoperative intestinal function and normal activity,QoR-40 score 24 h after operation,TAP block-related adverse reactions and postoperative nausea and vomiting were recorded.Results Compared with group R,the intraoperative consumption of remifentanil,the VAS score 2 h after operation was decreased significantly(P<0.05).The QoR-40 score in group BR were significantly higher than that in group R(P<0.05).There was no significant difference in intraoperative consumption of propofol,recovery time of intestinal function and ambulation,postoperative nausea and vomiting in the two groups.There was no TAP block-related adverse reactions happened in the two groups.Conclusion Combination of butorphanol and ropivacaine used in transversus abdominis plane block can reduce the intraoperative consumption of remifentanil,relieve postoperative pain and improve the quality of recovery after anesthesia.
作者
张鹤晨
张静
蔚冬冬
李攀
李建立
容俊芳
ZHANG Hechen;ZHANG Jing;YU Dongdong;LI Pan;LI Jianli;RONG Junfang(Department of Anesthesiology,Hebei General Hospital,Shijiazhuang 050051,China)
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2020年第2期156-159,共4页
Journal of Clinical Anesthesiology
关键词
腹横肌平面阻滞
布托啡诺
妇科腹腔镜手术
术后镇痛
早期康复
Transversus abdominis plane block
Butorphanol
Gynecological laparoscopy
Postoperative analgesia
Early rehabilitation
