曲马多切口局部浸润用于腹腔镜胆囊切除术术后镇痛

Postoperative analgesic effect of tramadol local infiltration in laparoscopic cholecystectomy

目的观察曲马多切口局部浸润用于腹腔镜胆囊切除术患者的术后镇痛效果。方法 83例择期行腹腔镜胆囊切除术ASAⅠ或Ⅱ级的患者,随机双盲分成4组,在缝皮前均进行切口局部浸润。N组:生理盐水;T组:曲马多2 mg/kg;B组:0.25%布比卡因;TB组:曲马多2 mg/kg+0.25%布比卡因,各组均稀释至5 ml。记录术后0、5 min和2、6、24 h的VAS、BCS评分,离床时间、排气时间、肩背疼痛及恶心呕吐等不良反应。结果 T、B、TB组VAS、BCS评分明显优于N组,差异有统计学意义(P<0.001);离床时间T组最短,排气时间B组短于N组,差异均有统计学意义(P<0.05)。结论 2 mg/kg曲马多切口局部浸润用于腹腔镜胆囊切除术术后镇痛效果,与0.25%布比卡因作用相当,且不良反应较少。

Objective To study the postoperative analgesic effect of tramadol local infiltration in laparoscopic cholecystecto- my. Methods Eighty - three patients ASA I - Ⅱ undergoing laparoscopic cholecystectomy were randomized to four groups in a double - blind manner. Group N received 0.9% normal saline, group T received 2 mg/kg tramadol, group B received 0.25% bupivacaine, group TB received 2 mg/kg tramadol ＋ 0.25% bupivacaine subcutaneously in volume of 5ml before closing the incision. The degrees of pain were recorded with the visual analog scale（VAS） at the points of 0,5 min,2,6,24 h. Leaving bed time, passing flatus time, shoulder and back pain , nausea and vomiting were recorded. Results Pain scores were statistically lower in groups T, B, TB than in group N（P 〈0. 001 ） ; the time of leaving bed in group T was shorter than in group N, the time of passingflatns in group B was earlier than in group N with statistically significant tsfference differences （ P 〈 0.05 ）. Conclusions Local infiltration of tramadol effects postoperative analgesia in the laparoscopic eholecystectomy similar to 0.25% bupivaeaine, and with fewer adverse effects.