摘要
目的观察比较开颅前行头部神经阻滞和（或）联合术后曲马多PCA（患者自控镇痛）对手术后疼痛的影响及镇痛效果。方法60例择期额颞部神经外科手术患者，ASAⅠ～Ⅱ级，用随机表法随机分为：①生理盐水对照组（n=20）；②长效利多卡因组（商品名克泽普）（n=20）；③罗哌卡因组（n=20）。麻醉诱导后根据手术切口部位进行眶上、耳颞、枕大、枕小神经阻滞。局麻药分别选用复方长效利多卡因、1％罗哌卡因和生理盐水。吸入异氟烷维持麻醉。术后采用曲马多PCA镇痛，检测术后2h、术后第1天和第2天疼痛视觉模拟评分（visual analog score，VAS）。结果术后2h对照组、长效利多卡因组、罗哌卡因组患者VAS评分分别为（42．0±19．7）mm、（25．2±16．4）mm和（38．6±24．5）mm，长效利多卡因组的VAS评分明显低于对照组，差异有统计学意义（P〈0．05）。术后第1、2天VAS评分较术后2hVAS评分降低，较对照组明显降低。结论术前行头皮神经阻滞可减轻术后的疼痛程度；联合术后曲马多PCA可达到满意的镇痛效果。
Objective To observe the effects of scalp nerve block combined with tramadol PCA on the postoperative pain undergoing craniotomy. Methods 60 adult patients （ ASA physical status Ⅰ or Ⅱ ） scheduled for frontotemporal craniotomies were randomly assigned into three groups： ropivacaine group （scalp nerve b]ock with 10 mL of ropivacaine 1% ）, long-lasting lidocaine group （ scalp nerve block with 10 mL of long-lasting lidocaine 0.8% ） and saline group （ scalp block with 10 mL of saline 0.9% ）. After the induction of general anesthesia, the scalp nerve block inc]uding the supraorbital nerve, the auriculotemporal nerves, and the greater, lesser occipital nerves was performed. The anesthesiologists performing the block were blinded to the drug being administered. Anesthesia was standarded. Patient-controlled analgesia （PCA） was used for the postoperative analgesia with tramadol. VAS scores were measured at 2 h, 24 h, 48 h after craniotomy. Results Average visual analog scale scores （VAS） within 2 h postoperative of saline, long-lasting lidocaine and ropivacaine group were （42.0 ± 19.7）mm, （25.2 ± 16.4）mm, （38.6 ±24.5）mm respectively . VAS were higher in the Saline group as compared with long-lasting lidocaine group（P 〈0.05） , VAS scores at 24 h and 48 h decreased as compared with VAS scores at 2 h, especially in the Saline group. Conclusion Scalp nerve block combined with tramadol PCA can successfully reduces postoperative pain after craniotomy.
出处
《首都医科大学学报》
CAS
2007年第1期128-130,共3页
Journal of Capital Medical University
