罗哌卡因不同方式局部浸润复合氟比洛芬酯对妇科腹腔镜手术的镇痛作用

Analgesic effect of different methods to use ropivacaine local infiltration combined with flurbiprofen in gynecological laparoscopy

目的：探讨静脉氟比洛芬酯复合不同方式罗哌卡因切口局部浸润用于妇科腹腔镜手术镇痛的用药时间和方法。方法：选择ASA I～Ⅱ级择期行妇科腹腔镜手术患者,均采取三切口手术入路（脐上1 cm Trocar入口和两侧腹0.5 cm Trocar入口）,所有患者采用气管插管全凭静脉麻醉,手术前后各给予氟比洛芬酯50 mg静脉注射,配制0.5%罗哌卡因20 ml,将患者随机分为4组,分别采用局部浸润：A组（n=15）、B组（n=14）切皮前给予罗哌卡因,C组（n=15）、D组（n=16）术毕缝合前给予局部浸润;A组、C组于脐上切口处给予0.5%罗哌卡因10 ml,下腹左右侧切口处各5 ml,B组、D组给予每个切口各6.6 ml罗哌卡因局部浸润。观察术中丙泊酚和瑞芬太尼的用量、术后疼痛VAS评分、需要曲马多补充镇痛的例数,以及术后不良反应。结果：4组间一般资料无显著差异;A组和B组丙泊酚用量显著低于C组和D组,A组瑞芬太尼用量显著少于其他3组;术后VAS评分各组间无统计学差异;需要应用曲马多补充镇痛的比例B组在术后2 h高于其他3组,其余时间点无显著差异;VAS评分组内比较4组术后12 h和术后24 h均显著低于前3个时间点;各组间术后恶心呕吐例数无显著差异。结论：0.5%罗哌卡因局部浸润复合氟比洛芬酯静脉注射对妇科腹腔镜手术有较满意的镇痛效果,术前使用罗哌卡因切口浸润可能节省静脉麻醉药物用量,根据切口和Trocar大小分布局麻药可能达到较好镇痛效果。

OBJECTIVE To prospectively study the analgesic effects of combining intravenous flurbiprofen with different methods of incision local infiltration of ropivacaine in gynecological laparoscopy.METHODS The subjects were ASA I-Ⅱ patients electively undergoing gynecological laparoscopy under total intravenous anesthesia（TIVA）with endotracheal intubation.The incisors were a supra-ubilical incisor for 1 cm-Trocar and bilaterosternal incisors for two 0.5 cm-Trocars.Intravenous flurbiprofen was administered pre-and postoperatively and ropivacaine was diluted into 20 ml 0.5%solution for each patient.The patients were randomized into four groups according to the methods to use ropivacaine infiltration：In group A（n=15）and group B（n=14）,0.5%ropivacaine infiltration was used preoperatively,whereas in group C（n=15）and group D（n=16）,ropivacaine infiltration was used postoperatively.In group A and group C,0.5%ropivacaine was used for 10 ml in supra-ubilical incision and 5 ml in each lateral incision,but in group B and group D,20 ml of 0.5%ropivacaine were used evenly in the three incisions.Intraoperative consumptions of propofol and remifentanil,postoperative VAS,the need of tramadol as supplementary analgesic and the side effects were recorded.RESULTS General data in the four groups were equivalent.Intraoperative consumptions of propofol in groups A and B were significantly lower than those of groups C and D.Intraoperative consumption of remifentanil in group A was significantly lower than that of other groups.There was no obvious difference among the groups considering VAS scores at each postoperative time point.But the number of patients who needed tramadol as supplementary analgesic was significantly more in group B than that in other group.Within each group the VAS at postoperative12 h and 24 h were obviously lower than those of the earlier postoperative time points.There was no difference among the groups on postoperative nausea and vomit.CONCLUSION Combined intravenous flurbiprofen with 0.5%ropivacaine incision local infiltration has a sound effect in postoperative analgesia for gynecological laparoscopy.Preoperative infiltration of ropivacaine could decrease the consumption of intravenous anesthetics.Local infiltration of ropivacaine according to the sizes of incision and Trocar may result in a good analgesia without additional side effects.