左旋布比卡因腹腔灌注在腹腔镜胆囊切除术后的镇痛效果

Intraperitoneal levobupivacaine for analgesia after iaparoscopic cholecystectomy

目的观察低浓度左旋布比卡因腹腔灌注用于腹腔镜胆囊切除术后镇痛的临床应用。方法择期行腹腔镜胆囊切除术ASAI～Ⅱ级的患者40例，随机分为两组每组20例，在手术结束后关闭腹腔前，I组（实验组）在腹腔指定部位灌注喷洒0．25％的左旋布比卡因60ml；Ⅱ组（对照组）腹腔灌注0．9％的生理盐水。两组患者均不采用任何术后镇痛方式。采用VAS（视觉模拟评分），分别在手术结束后的30min和1、2、6、12、24h对患者进行疼痛评估记分。并记录术后的不良反应和。结果对两组患者的连续观察中，在术后0．5～24h使用局麻药左旋布比卡因区域性腹腔灌注的镇痛组（I组）的平均VAS分数明显低于对照组（Ⅱ组），P〈0．05。且在整个镇痛过程中没有发现局麻药的毒性反应和其他的镇痛后不适。结论在腹腔镜胆囊切除术后腹腔不同部位灌注0．25％左旋布比卡因有较好的镇痛效果能减轻患者的疼痛，且无镇痛后的不良反应，是一种简单安全有效的镇痛方法。

Objective To assess the postoperative analgesic effect of intraperitoneal administra- tion of low - concentration levobupivacaine in patients undergoing laparoscopic cholecystectomy. Methods The clinical data of 40 patients（ ASA I - Ⅱ ）undergoing elective cholecystectomy were analyzed. At the end of the operation,patients were randomized into 2 groups. Each group had 20 patients. Group I （local anaesthetic group）received 60 mL 0.25% levobupivacaine sprinkled into the hepatodiaphragmatic space; Group Ⅱ （placebo group）received 60 ml 0.9% saline. All patients received none of other supplementary analgesia. Postoperative pain was assessed using a visual analogue scale（VAS） at 30th rain, 1 st ,2nd ,6 th, 12th and 24 th h respectively. The adverse reactions were recorded after analgesia. Results Mean pain scores were significantly lower in group I than in group Ⅱ from 30 min to 24 h after operation. Individual results from the 20 patients did not show any toxic reaction or other side effect of levobupivacaine during the whole study. Conclusion Intraperitoneal injection of levobupivacaine is an effective method for pain relief after laparoscopic choleeystectomy. This technique is simple, safe and effective with no apparent side effects.