肛肠手术后疼痛的防治

Postoperative analgesia with morphine and hyoscine preemptive analgesia through sacral canal for anorectal operation

目的观察椎管内注入吗啡和东莨菪碱预先镇痛对肛肠手术后的镇痛效果。方法64例骶管阻滞肛肠手术的患者,在骶管阻滞成功后3min,随机分为2组,每组32例。镇痛组(A组)骶管注入吗啡1.5-2mg和东莨菪碱0.2mg加生理盐水至5ml;对照组(B组)骶管注入生理盐水5ml。以视觉模拟评分法(VAS)评估疼痛程度,手术后4h、6h、8h、12h、24h和48h观察疼痛程度和患者的恢复情况。结果A组在各观察时点的VAS评分均小于或等于3分,B组则大于6分。A组患者的睡眠、进食、肛门功能恢复都好于B组;尿潴留和腹胀等副作用明显少于B组。结论骶管阻滞后加用吗啡和东莨菪碱预先镇痛可明显缓解肛肠手术后患者的疼痛,促进患者恢复。

Objective To explore efficiency of preemptive analgesia through sacral canal with morphine and hyoscine for postoperative pain relief in patients with anorectal operation. Methods 64 patients undergoing anorectal operation with sacral canal anesthesia were divided randomly into two groups, 32 patient in each group. In study group (A), the patients received morphine 1.5-2mg and hyoscine 0.2mg diluted with normal saline to 5ml injected into the sacral canal; in control group (B), the patients only received normal saline 5ml injected into the sacral canal. Visual analogue scale (VAS) was used for evaluating the pain. The VAS and patient conditions were recorded at 4h, 6h, 8h, 12h, 24h and 48h postoperatively. Results VAS were below 3 in group A at all recording time points, whereas, they were higher than 6 in group B at the same time. The sleeping, eating and recovery of anal function were much better, and urinary retention and meteorism were much less in group A than in group B. Conclusion preemptive analgesia with morphine and hyoscine through the sacral canal after sacral canal anesthesia can reduce postoperative pain significantly, and promote the recovery from the operation.