不同麻醉方式对腹股沟疝无张力修补术后早期切口疼痛与感觉的影响

Effects of different anaesthetic methods on early postoperative wound pain and aesthema after tension-free inguinal hernia repair.

目的:探讨局部麻醉和持续硬膜外麻醉对腹股沟疝无张力修补术后患者早期切口疼痛与感觉的影响。方法:60例行腹股沟疝无张力修补术患者,随机分成两组,其中局部麻醉组32例,硬膜外麻醉组28例。采用直观模拟量表(VAS)对两组患者术后早期切口疼痛进行评价;应用Semmes-Weistein 5.07/10g单尼龙丝检测法分别对两组患者术后早期局部切口疼痛区域和感觉减退区域进行描述;同时比较两组患者术后应用镇痛药物的情况。结果:术后第一天:局部麻醉组与硬膜外麻醉组相比,平静卧床VAS和切口局部疼痛区域差异有非常显著性(P=0.000),活动时VAS差异有显著性(P<0.05),咳嗽时VAS差异有显著性(P<0.05)。术后第二天:局部麻醉组与硬膜外麻醉组相比,活动时VAS(P=0.000)、咳嗽时VAS(P<0.05)和切口局部疼痛区域(P<0.01)差异有非常显著性,而平静卧床VAS差异无显著性(P>0.05)。术后第三天:局部麻醉组与硬膜外麻醉组相比,咳嗽时VAS差异有非常显著性(P<0.01),活动时VAS(P<0.05)和切口局部疼痛区域(P<0.5)差异有显著性,而平静卧床VAS差异无显著性(P>0.05)。术后第四天和第五天:两组之间各项疼痛指标差异无显著性(P>0.05)。术后切口感觉减退区域两组比较差异均无显著性(P>0.05)。术后12小时、1天、2天和4天:局部麻醉组与硬膜外麻醉组相比,术后应用镇痛药物人数百分比差异有非常显著性(P=0.000),术后第三天差异有显著性(P>0.05),而术后第五天差异无显著性(P<0.05)。局部麻醉组的住院时间较硬膜外麻醉组显著缩短(P=0.000)。结论:与持续硬膜外麻醉相比,局麻下行腹股沟疝无张力修补术,术后短时间(3天内)切口疼痛可明显减轻,缩短了住院时间;对于切口局部感觉减退两种麻醉方法没有区别。

Objective：To study the different effects between local anesthesia and epidural block anesthesia on early postoperative wound pain and aesthema after tension - free inguinal hernia repair.Methods：All of the 60 cases performed tension - free inguinal hernia repair were randomly divided into two groups, 32 cases were treated with local anesthesia and the other 28 cases were treated with epidural block anesthesia.In the early postoperation, wound pain was investigated with a visual analog scale （VAS）, and wound pain and hypoesthesia were assessed using yon Frey monofilaments （Semmes-Weistein5.07/10g）.To compare the using of pain-killer in two groups. Results：In the postoperative ld, the VAS on resting （P=0.000）, the VAS on walking （P=0.036） , the VAS on coughing （P=0.015）and wound pain area（P=0.000） of local anesthesia group were lower than those of epidural block anesthesia group. In the postoperative 2d, the VAS on walking（P=0.O00）,the VAS on coughing （P=0.004）and wound pain area（P=0.O04）of local anesthesia group were lower than those of epidural block anesthesia group,the VAS on resting were no significant differences （P=0.136）. In the postoperative 3d, the VAS on coughing （P=0.003） ,the VAS on walking （P=0.026） and wound pain area （P=0.024） of local anesthesia group were lower than those of epidural block anesthesia group,the VAS on resting were no significant differences （P=0.055）. In the postoperative 4-5d,the total pain indexs between both of groups had significant differences （P〉0.05）.In the postoperation, wound hypoesthesia area had no difference （P〉 0.05）.In the postoperative 12h, 1,2,3,4d,the percentage of patients using pain-killer of local anesthesia group was lower than that of epidural block anesthesia group（P〈0.05）,but that of postoperative 5d had no difference （P=1.000）.Length of stay of local anesthesia group was lower than that of epidural block anesthesia group（P=-0.000）.Coneluslon：Comparing to epidural block anesthesia ,local anesthesia can relieve wound pain in the early postoperation （3d） after tension - free inguinal hernia repair, and shorten the length of stay;but the way of anesthesia has no effect on wound hypoesthesia area.