罗哌卡因复合利多卡因切口浸润在异丙酚-瑞芬太尼全凭静脉麻醉下行乳腺癌改良根治术患者中的应用

The application of incision infiltration with ropivacaine mixed with lidocaine in patients receiving radical mastectomy under total intravenous anesthesia with propofol and remifentanil

目的观察0.25%罗哌卡因复合0.5%利多卡因切口浸润对异丙酚-瑞芬太尼全凭静脉麻醉下乳腺癌改良根治术术中血流动力学、麻醉及镇痛药物使用量、苏醒期疼痛的影响,以及对术后芬太尼静脉自控镇痛(PCIA)效果的影响。方法 40例择期行乳腺癌改良根治术的患者,随机分为两组。分别给予0.25%罗哌卡因+0.5%利多卡因混合液(浸润组,n=20)或生理盐水(对照组,n=20)切口浸润后5min切皮。两组术中均为异丙酚-瑞芬太尼全凭静脉麻醉维持至术毕。记录诱导前(T0)、局部浸润前(T1)的平均动脉压(MAP)和心率(HR);切皮(T2)及分离乳房后间隙(T3)过程中的MAP、HR峰值;记录术中异丙酚、瑞芬太尼总用量;记录拔管后5min的疼痛VAS评分以及苏醒期躁动Riker镇静-躁动(SAS)评分,以及术毕24h VAS评分和第1个24h内PCIA中芬太尼的用量以及按键次数。结果切皮与分离乳房后间隙时浸润组的MAP、HR峰值均明显低于对照组(P<0.01或P<0.05)。浸润组丙泊酚用量、瑞芬太尼用量、拔管后5min疼痛VAS评分、苏醒期SAS评分、第1个24h PCA中芬太尼用量及按键次数均明显低于对照组(P<0.01或P<0.05)。结论 0.25%罗哌卡因加0.5%利多卡因混合液切皮前切口浸润麻醉,能有效提高异丙酚-瑞芬太尼全凭静脉麻醉乳腺癌改良根治术血流动力学稳定性、减少术中异丙酚和瑞芬太尼用量、缓解苏醒期时的疼痛,并可减少患者术后24h内PCIA中芬太尼的用量。

Objective To study the influences of incision infihration with 0.25% ropivacaine mixed with 0.5% lidocaine on hemodynamic stability, intraoperative anesthetic requirements, recovery status, and on the effects of postoperative patient controlled analgesia（PCIA） with fentanyl in patients receiving radical mastectomy under total intravenous anesthesia with propofol and remifentanil. Methods Forty patients scheduled for radical mastectomy, were randomly divided into two groups：the infiltration group（n=20）, patients received incision infiltration with 0.25% ropivacaine mixed with 0.5% lidocaine 5min before skin incision and the control group（n=20）, patients received incision infiltration with normal saline instead. Anesthetic induction and maintenance were the same in the two groups. For both groups, hemodynamic changes and the total consumption of propofol and remifentanil during operation, Visual analog scale（VAS） scores at the time of 5min after extubation and sedation-agitation scale（SAS） scores during recovery stage were all recorded.The VAS scores 24h after operation, the total consumption of fentanyl and the number of keystrokes during the first 24h PCIA were also recorded. Results The peak values of MBP and HR measured at the time of skin incision and post- mammary space dissection, the VAS scores 5min after extubation, the SAS scores during recovery stage, the total consumption of fentanyl and the number of keystrokes during the first 24h PCIA were all significantly lower than those of the control group（P 〈 0.01 or P 〈 0.05）. Conclusion Incision infiltration with 0.25% ropivacaine mixed with 0.5% lidocaine, which can be easily implemented during surgery, could stabilize hemodynamics, reduce anesthetic consumption, and alleviate postoperative pain in patients receiving radical mastectomy under total intravenous anesthesia with propofol and remifentanil.