摘要
目的比较手术切皮前与手术结束缝皮前两个不同时间点切口局部浸润麻醉对腹腔镜子宫切除术后镇痛的效果。方法选取2023-06/2024-05期间南京大学医学院附属苏州医院择期行腹腔镜子宫切除术患者90例,年龄32~60岁,BMI 18.5~23.9 kg/m^(2),ASA分级Ⅰ或Ⅱ级,采用随机数字表法将患者分为三组:对照组(A组,n=30)、手术切皮前行切口局部浸润麻醉组(B组,n=30)、手术结束缝皮前行切口局部浸润组(C组,n=30)。A组单纯全身麻醉不进行切口局麻,B组在手术切皮前行切口局部浸润,C组在手术结束缝皮前行切口局部浸润。局麻药配方为0.33%罗哌卡因+0.67%利多卡因共15 mL,三组手术结束前15 min均予氟比洛芬酯50 mg缓慢静推。若患者术后疼痛视觉模拟评分(VAS评分)>3分,予静脉注射曲马多50 mg补救镇痛。记录术后2、6、12、24、48 h三组患者疼痛评分,并对比术后48 h内补救镇痛次数、术后首次下床活动时间、术后并发症发生情况。结果术后2、6、12、24 h疼痛评分B组、C组明显低于A组(P<0.05),差异有统计学意义;且术后2、6、12、24 h疼痛评分B组均低于C组,差异有统计学意义(P<0.05);术后48 h内补救镇痛率B组均低于A组、C组(P<0.05),差异有统计学意义。术后48 h疼痛评分、术后首次下床活动时间、并发症发生率比较三组患者差异无统计学意义(P>0.05)。结论腹腔镜子宫切除术患者术前切口局部浸润较术后缝皮前切口局部浸润术后镇痛效果更佳。
Objective To compare the analgesic effect of local infiltration anesthesia on laparoscopic hysterectomy at two different time points,before surgical incision and before suturing at the end of surgery.Methods Ninety patients,aged 32-60 years,BMI 18.5-23.9 kg/m^(2),ASAⅠorⅡ,underwent elective laparoscopic hysterectomy.The patients were divided into 3 groups,control group(group A,n=30),local infiltration anesthesia group before operation(group B,n=30),and local infiltration group after operation(group C,n=30),according to random number table method.The local anesthetic formula is 0.33%ropivacaine+0.67%lidocaine,totaling 15 mL.All three groups received slow intravenous injection of 50 mg flurbiprofen axetil 15 min before the end of the surgery.The pain scores of three groups of patients at 2,6,12,24,and 48 h after surgery were recorded,and the frequency of rescue analgesia within 48 h after surgery,the time of first ambulation after surgery,and the occurrence of postoperative complications were compared among three groups.Results Compared with group A,the pain scores of group B and group C was significantly reduced at 2,6,12,and 24 h after surgery(P<0.05);and the pain scores of group B at 2,6,12,and 24 h after surgery were lower than those in group C(P<0.05);the rescue analgesia rate of group B within 48 h postoperatively was lower than those of group A and group C(P<0.05).There was no statistically significant difference in postoperative pain scores,first mobilization time and the incidence of complications among three groups of patients at 48 h after surgery.Conclusion Compared with patients receiving local infiltration of the incision before suturing,patients undergoing laparoscopic hysterectomy have better postoperative analgesic effects after local infiltration of the incision before surgery.
作者
秦小凤
黄秋瑞
徐静
李华
屠伟峰
QIN Xiaofeng;HUANG Qiurui;XU Jing;LI Hua;TU Weifeng(Department of Anesthesiology,2 Department of Gynecology,The Affiliated Suzhou Hospital of Nanjing University Medicine School,Suzhou 215153,China)
出处
《麻醉安全与质控》
2024年第6期336-339,共4页
Perioperative Safety and Quality Assurance
基金
苏州市医学重点扶持学科(SZFCXK202109)。
关键词
腹腔镜子宫切除术
局部浸润麻醉
罗哌卡因
术后镇痛
预防性镇痛
laparoscopic hysterectomy
local infiltration anesthesia
ropivacaine
postoperative analgesia
preventive analgesia
