罗哌卡因局部浸润对小儿阑尾手术后疼痛的影响

Efficacy of wound infiltration with ropivacaine on postoperative pain relief after acute appendectomy in children

目的:观察局部浸润罗哌卡因对小儿阑尾术后的镇痛作用,并与吗啡进行对比。方法:40例4～13岁全麻下行阑尾切除术患儿,随机双盲分成罗哌卡因组:0.75%罗哌卡因(2.5mg/kg,皮下和腹横筋膜下浸润注射)+生理盐水(0.4mL/kg,i.v.),对照组:生理盐水(0.4mL/kg,皮下和腹横筋膜下浸润注射)+吗啡(50μg/kg,i.v.)。采用家长视觉模拟评分法(PVAS)和客观疼痛评分法(OPS),评估术后24h内不同时间段镇痛效果并记录疼痛分数、吗啡消耗量、应用吗啡人数以及恶心呕吐的发生率。结果:与吗啡对照组相比,罗哌卡因组PVAS评分和OPS评分除第24h时间段外,其余各时间段镇痛效果评分均无统计学意义(P>0.05);在术后0.5h时,罗哌卡因组吗啡消耗量[(2.4±10.9)μg/kg]明显低于对照组[(15.8±23.9)μg/kg],吗啡应用人数(1/21例)也少于对照组(6/19例),并具有统计学意义(P<0.05);术后24h内罗哌卡因组总的恶心呕吐发生率19%(4/21例)低于吗啡对照组42%(8/19例)。结论:罗哌卡因术后局部浸润镇痛效果类似于吗啡,能推迟术后首次要求吗啡镇痛的时间,减少吗啡的消耗量,且恶心呕吐发生率较低。

AIM： To assess the efficacy and safety of wound infiltration with ropivacaine compared with intravenous （i. v. ） morphine on postoperative pain relief after acute open appendectomy in children. METHODS： A prospective randomized double-blinded study was conducted on 40 patients aged 4 - 13 years with a preoperative and postoperative diagnosis of acute appendectomy. They were randomly divided into two groups： Ropivacaine Group （21 patients） and Control Group （19 patients）. Patients in Ropivacaine Group received wound infiltration with a dose at 0.4 ml/kg of 0.75% ropivacaine, then isotonic saline i.v. 0.4 mL/kg. Patients in Control Group received wound infiltration with isotonic saline at 0.4 mL/kg. then morphine i.v. 50 μg/kg. On the ward, the parents used a visual analog scale （PVAS） to assess pain score, 0 = no pain, 10 = worst possible pain. Meanwhile, a modified 10-point objective pain scale （OPS） was used by the anaesthetist to assess the pain score. Pain scores, morphine consumption and the incidence of nausea/ vomiting were recorded for 24 h. RESULTS： The average postoperative pain score （PVAS and OPS ） showed no statistical difference between the two groups （ P 〉 0.05） except during the 24 th hour postoperative period. During the 0.5 h postoperative period, the average total amount of injections of morphine was statistically lower in the ropivacaine group （control 15.8± 23.9μg/kg versus ropivacaine 2.4 ±10.9 μg/kg; P 〈0.05）; and there were 1 patient （4.76%） in the Ropivacaine Group and 6 patients （31.58%） in the Control Group who had morphine requirement, which also differed significantly between the two groups （ P 〈 0.05）. Although there was no significant difference in the incidence of postoperative nausea/vomiting, during the whole postoperative period, die incidence of postoperative nausea/vomiting was lower in the Ropivacaine Group .（control 42% versus ropivacaine 19% ）. CONCLUSION： The efficacy of wound infiltration with ropivacaine is similar to morphine （i. v. ） on postoperative pain relief after acute appendectomy in children. Ropivacaine delays the time to first morphine requirement and reduces the consumption of morphine. In addition, the incidence of postoperative nausea/vomiting is decreased.