曲马多术前骶管阻滞在妇科腹腔镜全麻术后镇痛效果中的应用——随机对照研究

Analgesic effects of preoperative caudal injection with tramadol in patients after receiving gynaecological laparoscopy under general anesthesia

目的观察曲马多术前骶管阻滞用于妇科腹腔镜全麻术后镇痛的效果。方法全麻下行妇科腹腔镜手术60例,随机分为2组,每组30例:A组术前经骶管注入含曲马多100 mg+2%利多卡因5 m l+恩丹西酮4 mg+生理盐水共20 m l溶液,B组手术结束前10 m in由莫非氏壶滴入曲马多100 mg+恩丹西酮4 mg。采用VAS评分和Ram say镇静评分对患者拔管后、离室前以及术后1、3、6 h进行痛觉和镇静程度评分,并记录有无躁动、头晕、嗜睡、恶心、呕吐等不良反应。结果A组拔管后,离室前,术后1、3 h的VAS评分显著低于B组(t=-5.961,-8.362,-4.038,-3.565;P=0.000),术后6 h VAS评分2组无显著性差异(t=-1.403,P=0.166);A组患者的镇静评分在拔管后,离室前,术后1、3 h明显高于B组(t=9.409,10.407,8.167,4.082;P=0.000),2组术后6 h的镇静程度评分无显著性差异(t=0.428,P=0.670)。B组患者拔管后、离室前躁动及术后头晕、恶心、呕吐的发生率明显高于A组(2χ=12.000,P=0.001;2χ=9.600,P=0.002;2χ=13.017,P=0.000)。结论曲马多100 mg术前骶管阻滞是妇科腹腔镜全麻术后较好的镇痛方法之一。

Objective To observe the analgesic effects of preoperative tramadol caudal injection in patients after receiving gynaecological laparoscopy under general anesthesia. Methods A total of 60 patients scheduled for gynaecological laparoscopic operations under general anesthesia was randomly divided into two groups with 30 patients each. The Group A was given an injection of tramadol 100 mg, 2% lidocaine 5 ml, ondansetron 4 mg, and normal saline 20 ml by caudal route preoperatively, while the Group B was given an intravenous drip of tramadol 100 mg and ondansetron 4 mg at 10 minutes before the end of operation. The Visual Analog Scale （VAS） pain scores and the Ramsay Sedation Scores were recorded after extubation, before the departure from operation room, and at 1, 3, and 6 hours after surgery, respectively. Adverse effects of dysphoria, dizziness, drowsiness, nausea, and vomiting were recorded. Results The VAS scores were significantly lower after extubation, before the departure from operation room, and at 1 and 3 hours after surgery in the Group A than in the Group B （t = -5.961, -8.362, -4.038, -3.565; P =0.000）, while the difference was not significant between the two groups at 6 hours after surgery （t = -1.403, P = 0.166）. The Ramsay scores were significantl higher after extubation, before the departure from operation room, and at 1 and 3 hours after surgery in the Group A than in the Group B （t = 9.409, 10.407, 8.167, 4.082; P = 0.000）, while the difference was not significant between the two groups at 6 hours after surgery （t = 0.428, P = 0.670）. Significantly more patients presented dysphoria, dizziness, nausea, and vomiting in the Group B than in the Group A after extubation and before the departure from operation room. Conclusions Tramadol 100 mg caudal injection before operation can produce a better postoperative analgesic effect in patients receiving gynaecological laparoscopic operations.