罗哌卡因浸润麻醉对脊髓损伤患者术后镇痛的影响

Effect of Ropivacaine in Infiltration Anesthesia for Postoperative Analgesia on Patients with Spinal Cord Injury

目的观察在手术结束前应用罗哌卡因局部浸润对脊髓损伤患者术后镇痛的影响。方法60例美国麻醉医师协会（ASA）分级I～Ⅱ级拟在静吸复合全麻下行骨折切开复位内固定的脊髓损伤患者，分为3组：低浓度罗哌卡因浸润麻醉组（RL组，n=20）在手术结束前应用0．25％罗哌卡因对手术切口进行局部浸润麻醉；中浓度罗哌卡因浸润麻醉组（RM组，n=20）在手术结束前应用0．5％罗哌卡因对手术切VI进行局部浸润麻醉；对照组（C组，n=20）在手术结束前直接缝合切口，不给予任何局部麻醉药。观察患者术后2h、6h、24h、48h的疼痛视觉模拟评分（VAS），观察麻醉恢复时间及手术结束后的躁动评分及相关副作用发生情况。结果RL组和RM组患者在全麻苏醒期及术后6h内的躁动评分低于C组（P〈0．05），RL组和RM组患者在术后2h、6h、24h的VAS评分、平均动脉压及心率低于C组（P〈0．05），恢复时间较C组显著缩短（P〈0．001）。3组问的副作用发生率无显著性差异（P〉0．05）。结论罗哌卡因局部浸润麻醉能够有效地降低脊髓损伤患者术后疼痛，减轻术后躁动。

Objective To observe the effect of ropivacaine in infiltration anesthesia before the end of surgical procedures for postopera- tive analgesia on patients with spinal cord injury. Methods 60 patients with spinal cord injury undergoing internal fixation of spine fractures under combined general anesthesia were assigned in 3 groups, who received 0.25% ropivacaine in infiltration anesthesia （group RL, n=20）, 0.5% ropivacaine in infiltration anesthesia （group RM, n=20）, or no infiltration anesthesia （group C, n=20） before the end of surgical proce- dures. The time for post-anesthesia recovery （PART）, agitation score （AS）, and Visual Analogue Score （VAS） for pain 2 h, 6 h, 24 h, and 48 h post operation were recorded, and related side effects were observed. Results AS within 6 h postoperation was significantly less in group RL and RM than in group C （P〈0.05）, as well as VAS, PART, mean of arterial pressure and heart rate 2 h, 6 h, and 24 h post operative （P〈 0.05）.There was no significant difference in side effects including postoperative nausea and vomiting, and pruritus among these groups （P〉 0.05）. Conclusion Ropivacaine in infiltration anesthesia would provide better postoperative analgesia, decrease the incidence of postopera- tive agitation, and increase the safety of patients with spinal cord injury in the postoperative period.