0．2％左旋布比卡因切口局部持续镇痛用于剖宫产术后镇痛的效果

Efficacy of continuous incision analgesia with 0.2 % ievobupivacaine for postoperative analgesia in parturi- ents undergoing cesarean section

目的评价0．2％左旋布比卡因切1：7局部持续镇痛用于剖宫产术后镇痛的效果。方法择期拟行剖宫产术孕妇30例，年龄20～30岁，体重60-80kg，ASA分级Ⅰ或Ⅱ级，术毕采用切口局部持续镇痛装置给予0．2％左旋布比卡因，剂量2ml／h。采用VAS评分法评价疼痛程度，VAtS评分〉3分，追加曲马多50mg，记录术后48h内镇痛有效（未追加曲马多，VAS评分≤3分）情况及追加曲马多用量；于术前30min、术后24和48h时测定血清泌乳素浓度，记录初乳时间，观察局麻药中毒、不良反应的发生情况。结果术后48h内镇痛有效率为80％，追加曲马多用量为（95±15）mg，初乳时间为（24±6）h；未见局麻药中毒反应发生。与术前30min时比较，术后24和48h时血清泌乳素浓度升高（P〈0．05）。结论0．2％左旋布比卡因切口局部持续镇痛用于剖宫产术后镇痛的效果较好，产妇泌乳早，不良反应少。

Objective To evaluate the efficacy of continuous incision analgesia with 0.2 % levobupiva- caine for postoperative analgesia in parturients undergoing cesarean section. Methods Thirty ASA physical status or Ⅱ parturients who were at full term, aged 20-30 yr, weighing 60-80 kg, undergoing elective cesarean sec- tion, were enrolled in the study. The parturients received 0.2% levobupivacaine 2 ml/h via a continuous incision analgesia device at the end of surgery. Pain was evaluated by visual analogue scale （VAS）. Additional tramadol 50 mg was given when VAS score was above 3 and the consumption was recorded. The effective analgesia within 48 h after surgery （ no addition of tramadol, VAS score ≤ 3） was recorded. The serum prolactin level was measured at 30 rain before cesarean section and 24 and 48 h after cesarean section. The colostrum time was recorded. The toxic reaction and side effects were recorded. Results The effective analgesia rate was 80 % . The consumption of tram- adol was （95 ：t： 15） mg. The colostrum time was （24 ＋ 6） h. No toxic reaction was found. The serum prolactin level was significantly higher at 24 and 48 h after surgery than that at 30 min before surgery （ P 〈 0.05）. Conclu- sion Continuous incision analgesia with 0.2% levobupivacaine provides better efficacy, earlier colostrum time and fewer side effects for postoperative analgesia in parturients undergoing cesarean section.