局部及静脉联合用药超前镇痛对椎管内麻醉穿刺的影响

Effect of preemptive analgesia with local and intravenous medication on intraspinal anesthesia puncture

目的探讨局部及静脉联合用药超前镇痛对椎管内麻醉穿刺过程临床镇痛效果、麻醉体位配合的满意度、麻醉穿刺一次成功率的影响。方法择期行腹股沟疝修补术的患者80例,年龄36～60岁,体重48～75kg,ASA分级Ⅰ～Ⅱ级,采用随机数字表法,将其随机分为两组各40例。A组患者入室后立即在椎管内麻醉穿刺点为中心2cm2的皮肤范围内用2%利多卡因均匀的涂布两遍,开放静脉通路后静注地佐辛10mg,C组穿刺点及静脉用等量生理盐水。记录两组患者皮肤局麻进针时(T1)、椎管内麻醉穿刺过程(T2)的疼痛评分,麻醉穿刺时患者体位变动(体动),麻醉穿刺一次成功率,患者满意度及不良反应(头晕、恶心、呕吐)。结果与C组比较,A组在T1、T2的VAS评分明显降低(P<0.05),患者体动明显减少(P<0.05),麻醉穿刺一次成功率明显增加(P<0.05),患者满意度高;两组患者恶心、呕吐及头晕发生例数比较差异无统计学意义(P>0.05)。结论局部及静脉联合用药超前镇痛对减轻患者椎管内麻醉穿刺过程的紧张、焦虑及疼痛效果确切,体位配合好,麻醉穿刺一次成功率高,患者满意度高,有明显的临床意义。

Objective To investigate the effect of preemptive analgesia with local and intravenous medication on the analgesic effect during puncture procedure, the degree of satisfaction for anesthesia puncture posture, and the one-time success rate of anesthesia puncture. Methods Eighty patients of elective inguinal hernia （aged 36-60 years old, weighted 48-75 kg）, classified as ASA I - II, were divided into the observation Group （group A, n=40） and the control group （C, n= 40） by a randomized single-blind method. Patients of group A were given 2% lidocaine twice immediately on the spinal anesthesia puncture point and 2 cm2 skin surface around, followed by injection of 10 mg Dezocine intravenously. Patients of group C were given saline instead of lidocaine, followed by equal amount of saline solution injected intravenously. Pain scores at the puncture of local anesthesia （T1） and during spinal anesthesia puncture procedure （T2）, postural changes during anesthesia puncture （movement）, one-time success rate of anesthesia puncture, patient satisfaction and side effects （dizzi- ness, nausea, vomiting） were recorded. Results Compared with group C, VAS scores of group A significantly decreased at T, and T2 （P〈0.05）, postural changes reduced significantly （P〈0.05）, the once-time success rate of anesthesia puncture increased significantly （P〈0.05）, and the patient satisfaction was higher. No statistically significant difference was found be- tween the two groups in side effects, including nausea, vomiting and dizziness （P〉0.05）. Conclusion Preemptive analgesia with local and intravenous medication is effective to relieve stress, anxiety and pain during spinal anesthesia, with good body position, high one-time success rate, and high patient satisfaction.