腹腔镜胆囊切除局部镇痛的临床研究

目的探讨腹腔镜胆囊切除气腹前在打孔处皮肤至腹膜之间用左布比卡因局麻和胆囊床放置左布比卡因、芬太尼混合液的明胶海棉,观察其对腹腔镜胆囊切除术后疼痛的影响。方法 50例腹腔镜胆囊切除术的患者,随机分成治疗组和对照组,每组25例。治疗组气腹前,用20mL0.25%左布比卡因在腹壁3个打孔处局部麻醉。并于胆囊切除止血后,胆囊床处放置用5mL0.5%左右布比卡因和0.05mg芬太尼混合液浸透的明胶海绵两片。对照组除腹壁浸润注射生理盐水外,并在胆囊切除后,静脉给予0.05mg芬太尼。评估和记录术后1、2、3、6、9和24h的VAS评分。如果患者VAS>40时,给予肌注哌替啶50mg。结果治疗组在所有观察时间点VAS评分值小于对照组(P<0.05),术后需要镇痛和右肩痛的发生率低(P<0.05)。结论腹壁局部麻醉和胆囊床放置含左布比卡因和芬太尼的明胶海绵,对腹腔镜胆囊切除术后的疼痛有明显镇痛作用,是一种安全、简单、副作用少的镇痛方法。

Objective To investigate the effect of postoperative pain of laparoscopic cholecystectomy.Methods 60 patients undergoing laparoscopic cholecystectomy were randomly assigned into two groups（n=30 in each group）.Therapy group and control group.Before carbon dioxide pneumoperitoneum,the area of drilling were given local anesthesia with 20mL 0.25% L-bubivacine,after gallbladder removal,two compound of 5mL 0.5% L-bubivacine and 0.05mg fentanyl gelfoams were put in the gallbladder bed in the therapy group;in the control group,the saline was given in the area of drilling,after gallbladder removal,0.05mg fentanyl was given（i.v）.the VAS score at 1h,2h,3h,6h,9h,and 24h were recorded.if VAS〉40,50mg dolantine was given（im）.Results The VAS score were obviously lower in the therapy than control group（P〈0.05）.the needing of postoperative analgesia and the occur of right shoulder pain are more smaller（P〈0.05）.Conclusion The area of drilling being given local anesthesia and the compound of 5mL 0.5% L-bubivacine and 0.05mg fentanyl gelfoams being put in the gallbladder bed can reduce the postoperative pain of laparoscopic cholecystectomy.