罗哌卡因局部浸润麻醉对腹股沟疝日间手术后早期切口疼痛的影响

Effects of ropivacaine infiltration on early postoperative pain after day surgical repair of inguinal hernia

目的探讨罗哌卡因局部浸润麻醉对腹股沟疝日间手术后早期切口疼痛的影响,寻找影响早期切口疼痛的因素。方法回顾性分析2009年5月至2013年4月,首都医科大学宣武医院接受腹股沟疝日间手术,且在术毕接受罗哌卡因浸润麻醉患者的临床资料。于术后4、8、12、24、48 h记录患者的疼痛评分。多元Logistic回归分析寻找术后早期切口疼痛的独立危险因素。结果共721例患者进入研究,患者术后4、8、12、24、48 h VAS评分分别为(2.52±1.47)分、(2.80±1.54)分、(1.72±0.89)分、(1.33±1.01)分、(0.46±0.25)分。WHO疼痛分级>Ⅰ级患者比例分别为11.8%(85/721)、15.9%(115/721)、8.5%(61/721)、5.1%(36/721)、1.2%(9/721)。116例(16.1%)患者需要额外口服NSAIDs类止疼药,9例(1.2%)需要弱阿片类药物。回归分析表明患者年龄及BMI是术后早期疼痛的独立危险因素。结论罗哌卡因能使疝日间手术患者术后切口疼痛感处于一个较低的水平,患者年龄及BMI指数与术后早期疼痛显著相关。

Objective To explore the effects of ropivacaine infiltration on and risk factors for early postoperative pain after day surgical repair of inguinal hernia.Methods Retrospectively analyzing the medical records of patients receiving ropivacaine infiltration at the end of day surgical repair of inguinal hernia who admitted to our department between May 2009 and April 201 3.Postoperative pain was evaluated at 4,8,1 2,24 and 48 hours after surgery.Multivariate logistic regression analysis was performed to determine the independent risk factors for early postoperative pain.Results A total of 721 patients were included in our study.Postoperative VAS pain score was （2.52 ±1 .47）,（2.80 ±1 .54）,（1 .72 ±0.89）,（1 .33 ± 1 .01 ）and （0.46 ±0.25 ）at 4,8,1 2,24 and 48 hours after surgery,respectively.There were 1 1 .8%, 1 5.9%,8.5%,5.1% and 1 .2% patients respectively,whose pain level greater than WHO classification level I.About 1 1 6 patients （1 6.1%）needed additional NSAIDs,and 9 patients （1 .2%）needed opioids as painkillers.Results of logistic regression analysis showed that age 〈40 years and BMI 〈22 were the independent risk factors for early postoperative pain.Conclusions Ropivacaine could make the early postoperative pain at a relatively low level after day surgical repair of inguinal hernia.Patient＇s age,and BMI were significantly associated with early postoperative pain.