左布比卡因局部浸润对腹腔镜胆囊切除术术后镇痛效果的临床观察

Effect of incisional levobupivacaine on pain after laparoscopic cholecystectomy

目的研究腹腔镜胆囊切除术(LC)切口行左布比卡因局部浸润止痛的最佳时机及对术后的镇痛效果。方法选择90例择期行腹腔镜胆囊切除术的患者,随机分为三组,每组30例。A组在切皮前予0.5%左布比卡因20ml行切口全层浸润;B组在手术结束缝皮前予0.5%左布比卡因20ml行各切口全层浸润(剂量同A组);C组不予切口局部麻醉处理。分别观察记录术后2h、4h、12h,24h、48h患者安静时的疼痛视觉模拟(VAS)评分,术前1天和术后2h、4h、12h、1d晨、2d晨血清葡萄糖、皮质醇、β-内啡肽水平,并记录术后镇痛药的使用情况。结果三组患者术后2h、4h、12h、24hVAS评分,差异有统计学意义(F分别=50.00、22.58、12.57、7.90,P均<0.05);A组和B组间比较,差异无统计学意义(F分别=0.60、0.49、0.44、0.81,P均>0.05)。A、B组术后2h、4h、12h的血清葡萄糖、皮质醇,术后2h、4h、12h、术后第1天晨的β-内啡肽水平均显著低于C组,差异有统计学意义(F分别=17.38、13.78、15.82、7.78、22.08、5.98、8.26、6.80、11.20、4.78,P均<0.05);A组和B组间的差异无统计学意义(F分别=0.29、0.28、0.42、0.20、0.49、0.22、0.45、0.60、0.60、0.50,P均>0.05)。A、B组术后镇痛药的使用例数少于C组,差异有统计学意义(χ2=6.47,P<0.05)。C组镇痛药首次应用时间早于A组和B组,差异有统计学意义(F=17.86,P<0.05);A组和B组间的差异无统计学意义(F=0.87,P>0.05)。结论左布比卡因局部浸润对腹腔镜胆囊切除术后镇痛安全有效,术前浸润和术后浸润的镇痛效果无差异。

Objective To study the effect of local infiltration anesthesia with levobupivacaine after laparoscopic cholecystectomy （LC）. Methods A total of 90 cases of LC patients were randomly divided into 3 groups, 30 cases each. Group A： applied a full infiltration of the cut with 20 ml of levohupivacaine （0.5%） before operation. Group B： applied a full infiltration of the cut with 20 ml of levohupivacaine （0.5%） before skin suture （ the same dose as in group A）. Group C： applied no local infiltration anesthesia to the cut. The visual analogue scale （VAS） on patients in quiet condition after 2, 4, 12, 24,and 48 hours from operation were observed respectively; serum glucose, cortisol, and beta endorphins level 1 day before the operation, 2, 4, 12 hours, 1 and 2 days after the operation were tested respectively; the application of analgetie after the operation were recorded. Results The results of the following figures in group A and B were significantly lower than those in group C： VAS scores after 2, 4, 12,and 24 hours from the operation; the serum glucose and cortisol levels after 2, 4, and 12 hours from the operation; beta endorphins level after 2, 4, 12 hours, and 1 day from the operation （F=50.00,22.58,12.57,7.90,17.38,13.78,15.82,7.78,22.08,5.98,8.26,6.80,11.20,4.78,P〈0.05）. There were no significant differences between group A and B（F=0.29, 0.28, 0.42, 0.20, 0.49, 0.22, 0.45, 0.60, 0.60, 0.50,P〉 0.05）. Cases use analgetic had significant difference between the three groups （X2=6.47,P〈0.05）. The initial time of analgetic using was significantly earlier in group C than that in the other two groups （F=17.86,P〈0.05） ; There were no significant difference between group A and B （F=0.87,P〉0.05）. Conclusions Applied either before or after the operation, local infiltration anesthesia proves to be simple and effective in the analgesia process of LC.