罗哌卡因切口注射对老年胃癌病人全麻术后疼痛影响

EFFECT OF INCISION INFILTRATION OF ROPIVACAINE ON POSTOPERATIVE PAIN IN ELDERLY PATIENTS UNDERGOING SURGERY FOR GASTRIC CANCER UNDER GENERAL ANESTHESIA

目的观察罗哌卡因手术切口注射对老年胃癌病人术后疼痛的影响。方法ASAI～Ⅱ级老年胃癌术后病人60例，随机分为正常剂量静脉白控镇痛组（IV组）、罗哌卡因切口注射加正常剂量静脉自控镇痛组（NIV组）和罗哌卡因切口注射加低剂量静脉镇痛组（NRV组）3组。IV组于病人人麻醉恢复室内开始应用静脉镇痛泵镇痛，药物为舒芬太尼100μg＋哌替啶100mg＋托烷司琼5mg；NIV组将3．75g／L罗哌卡因20mL于缝皮前切VI注射＋静脉镇痛泵，镇痛泵药量同IV组。NRV组静脉应用舒芬太尼100μg＋哌替啶50mg＋托烷司琼5mg，罗哌卡因的用量同NIV组。病人进入麻醉恢复室后每30rain进行1次术后疼痛评分，至术后3h，然后于5、9、15和21h各评估1次。如果病人在静息状态下疼痛评分大于30mm，则静脉注射曲马多50mg。结果术后3组痛疼视觉模拟评分比较差异无显著性（P〉0．05）；在所观察的24h内IV组、NIV组及NRV组病人需要静脉注射曲马多的例数分别为2、1、2例，组间比较差异无显著性（P〉0．05）。结论在保证镇痛效果的情况下，切口注射罗哌卡因可以减少老年病人术后麻醉性镇痛药的用量，降低麻醉性镇痛药的不良反应，有利于老年病人术后恢复及观察。

Objective To investigate the postoperative analgesia of incision infiltrating ropivacaine in elderly patients un- dergoing surgery for gastric cancer under general anesthesia. Methods Sixty patients-aged 65--75 years, ASA I -- lI grade- were randomly assigned to three groups： IV group, the patients received self-controlled normal intravenous dose analgesia pump; NIV group, incision injection of ropivacaine plus self-controlled normal intravenous dose analgesia pump; and NRV group, ropiva- caine plus low-dose intravenous analgesia. The patients in IV group were given analgesia with analgesia pump of sufentanyl 100μg- petidine 50 mg＋tropisetron 5 rag; those in NIV group were given infiltrating of 3.75 g/L ropivacaine 20 mL before closing the inci- sion ＋ patient-controlled analgesia pump, the dosage of the pump was the same as that in the IV group; those in NRV group re- ceived sufentanyl 100 big ＋petidine 50 mg＋tropisetron 5 mg, the dosage of ropivacaine was the same as NIV group. The score of postoperative pain was recorded every 30 minutes for the first 3 hours in anesthetic recovery room, and then at 5, 9, 15 and 24 h. If VAS〉30 ram, intravenous tramadol of 50 mg was administered. Results The VAS score of postoperative pain was similar between the three groups （P〉0.05）. Within 24-hour observation, the need of intravenous tromadol in IV, NIV and NRV group was two, one and two patients, respectively, no significant difference between them （P〉0.05）. Conclusion In the case of ensu- ring effectiveness of analgesia, incision infiltration of ropivacaine can reduce the dosage of narcotic analgesic in the aged after surge- ry and decrease its side effects, which is beneficial to their postoperative recovery and observation.