多模式镇痛在妇科腹腔镜手术中的应用

The clinical observation of multiple model analgesia after laparoscopic gynecologic operation

目的观察多模式镇痛对妇科腹腔镜手术患者术后痛的影响。方法60例择期行妇科腹腔镜手术患者完全随机分为3组：超前镇痛组采用0．125％布比卡因50m1进行切口浸润和腹腔内注射喷洒，麻醉诱导前静脉注射2ml曲马多2mg／kg；术后镇痛组同等剂量的0．125％布比卡因50ml在手术结束前使用，手术结束前静脉注射2ml曲马多2mg／kg；对照组采用相同的布比卡因，并静脉注射2ml的生理盐水。分别于术后1、4、8、12、和24h采用视觉模拟评分（VAS）、舒适度评分（BCS）评分评价3组患者疼痛程度，记录需要镇痛药物时间和镇痛药物用量以及不良反应的发生。结果与对照组相比，术后1、4、8h超前镇痛组和术后镇痛组的VAS及BCS舒适度评分明显降低（对照组：5．3±1．3、4．6±1．2、4．6±1．1；超前镇痛组：3．4±0．7、3．1±0．6、2．8±0．6；术后镇痛组：3．2±0．6、3．3±0．7、3．1±0．8；P〈0．01），而12、24h则差异无统计学意义；超前镇痛组和术后镇痛组相比，除24h2组的VAS差异有统计学意义（2．4±0．7比3．1±0．5，P〈0．05）外，之前各时点2组之间VAS及BCS评分无统计学意义（P〉0．05）。术后24h内镇痛药需求例数、超前镇痛组与术后镇痛组差异无统计学意义，但均明显低于对照组（P〈0．01）。3组患者术后不良反应发生率差异无统计学意义（P〉0．05）。结论多模式术后镇痛可明显减轻妇科腔镜手术患者术后切口疼痛。

Objective To explore the effect of laparoscopic gynecologic operation after general anesthesia for multiple model analgesia. Methods Sixty patients undergoing laparoscopic gynecologic operation were randomized into three groups. Beforehand analgesia group received tramadol 2 mg/kg iv before surgery and local infiltration with 50 trd 0. 125% bupivacaine at the end of surgery. Postoperative analgesia group received tramadol 2 mg/kg iv after surgery and 50 ml 0. 125% bupivacaine at the end of surgery. Control group received placebos. All patients had a standard anaesthetic, visual analogue scale scores （VAS）and comfort scores （BCS）for postoperative analgesia at 1 h, 4 h,8 h, 12 h and 24 h, cumulative analgesic consumption, time until first analgesic medication request and adverse effects were recorded. Results The VAS and BCS scores of pain in beforehand analgesia group and postoperative analgesia group were significantly lower than that in control group at 1 h,4 h and 8 h postoperatively （P 〈 0. 01 ）. At 24h, the VAS scores of beforehand analgesia group was lower than that of postoperative analgesia group. At 12h and 24 h postoperatively; BCS scores showed no statistical differences among the three groups. The consumption of analgesics was significantly higher in beforehand analgesia group and postoperative analgesia group than that in control group. There were no differences among the three groups regarding adverse effects. Conclusion Multiple model analgesia may reduce pain in patients undergoing laparoscopic gynecologic operation.