胆囊窝注入罗哌卡因配伍甲强龙用于预防腹腔镜胆囊切除术后疼痛和恶心呕吐

目的考察胆囊窝内注入罗哌卡因与甲强龙混合液用于防治腹腔镜胆囊切除术(LC)术后疼痛及恶心呕吐的效果。方法选择择期行LC术病人60例,随机分为两组,每组30例。观察组用药为1%罗哌卡因10ml+甲强龙40mg用生理盐水稀释至20ml;对照组为生理盐水20ml,在胆囊切除后分别注入胆囊窝。采用VAS评分观察记录患者术后1、4、8、12、24h静息时腹腔内、肩部和切口疼痛,以及咳嗽时的疼痛程度。在术后24h观察恶心、呕吐评分。结果观察组患者术后1、4、8h静息时的切口痛和咳嗽时的疼痛VAS评分均低于对照组。观察组患者术后1、4、8、12h静息时腹腔内疼痛VAS评分显著低于对照组。观察组患者术后24h呕吐发生率(10.0%)明显低于对照组(53.4%)。结论胆囊窝内注入罗哌卡因配伍甲强龙混合液可显著降低LC术后疼痛,对术后恶心呕吐也有一定防治作用。

Objective To evaluate the prophylactic and therapeutic effects of ropivacaine combined with methylprednisolone injected into the fossa gallbladder on the postoperative pain and postoperative nausea and vomiting （PONV） of patients undergoing laparoscopic cholecytectomy （LC）. Methods Sixty patients were randomly divided into two groups as control and investigation group. 10ml of 1% ropivacaine and 40mg of methylprednisolone diluted to 20ml by normal saline were injected into the fossa gallbladder of the investigation group patients, while, 20ml of normal saline for the control group patients immediately after the cholecytectomy. The postoperative pain during the rest （intraperitoneal, the shoulder and incision areas） and cough were measured at the time points of 1, 4, 8, 12, and 24h after surgery, and the PONV were also detected and compared 24h after operation. Results The postoperative pain levels during the cough or within the incision areas of the investigation group were obviously lower than those of control group at the time points of lh, 4h, 8h after surgery. There were significant differences of the intraperitoneal pain at the time points of 1h, 4h, 8h, 12h between the investigation group and control group. The vomiting rates 24h after operations had a significant difference between the two groups, as 10.0% in the investigation group, and 53.4% in the control group. Conclusion 20ml of mixed solution of ropivacaion and metbylprednisolone injected into the fossa gallbladder can obviously reduce postoperative pain and PONV of patients undergoing laparoscope cholecvtectomv.