外周吗啡对腹腔镜胆囊切除术后疼痛影响

The Influence of Peripheral Morphine Aministration on Analgesia in Laparoscopic Cholecystectomy

目的评价外周吗啡给药对术后疼痛影响。方法200例腹腔镜胆囊切除术病人随机分为5组,组M(n=40)术前10分钟穿刺点处局部浸润含2mg吗啡生理盐水20ml;组B(n=40)局部浸润0.25%布比卡因20ml,组M+B(n=40)含2mg吗啡0.25%布比卡因20ml,组S(n=40)局部浸润0.9%NaCl20ml,组S+M(n=40)穿刺点处局部浸润0.9%NaCl20ml和皮下注射吗啡2mg。术后根据病人需要给予曲马多止痛并VAS法评估疼痛。记录曲马多总消耗量,术毕距第一次给药时间,副作用发生率(恶心,呕吐,嗜睡)。结果疼痛程度,曲马多消耗量组M,B,M+B比组S,S+M较低,但无统计学意义。术毕距第一次给曲马多时间组M,B,M+B组比组S,S+M。明显延长(P≤0.05)。结论外周吗啡给药能够减轻术后疼痛。

Objective To evaluate the influence of peripheral morphine administration on analgesia in postoperations. Methods Two hundreds patients by laparoscopic cholecystectomy were divided into 5 groups randomly. Group M （n=40） local infiltration round insertion points with 2 mg morphine in 20 ml of 0.9% NaCl 10 minutes preoperation. Group B （n=40） ,the solution used for infiltration was 20 ml of 0.25% bupivacaine; group M＋B （n：40） ,the solution was 2 mg morphine in 20 ml of 0.25% bupivacaine; and group S （n=40） ,the solution was 20 ml 0.9% NaCl. Group S＋M （n=40） ,infiltrated with 20 ml of 0.9% NaCl round insertion points,and gave 2 mg of subcutaneous morphine 10 minutes preopcration. Postoperative analgesia was provided with tramadol when requirement. VAS when 4,8,12 h, total tramadol requirement, time from operation finished to tramadol administrated firstly,and the frequency of adverse reactions （nausea,and vomiting,drowsiness）. The above all were measured. Results VAS and total tramadol requirement were few in groups M,B,and M＋ B compared with groups S and S＋ M, but these differences were not statistically significant. Time from operation finished to tramadol administrated firstly was significantly longer in groups M,B, and M＋ B compared with groups S and S＋ M （P 0.05）. Conclusions the positive influence of peripheral morphine administration on analgesia in the postoperative period is confirmed.