罗哌卡因切口浸润联合鞘内吗啡用于剖宫产术后镇痛的临床研究

Clinical study of incisional ropivacaine infiltration combined with intrathecal morphine for postoperative analgesia after caesarean section

目的探讨罗哌卡因切口浸润联合鞘内吗啡用于单纯腰麻下剖宫产术后镇痛的效果和不良反应。方法将60例择期腰麻下剖宫产产妇随机分为A组和B组,各30例。术后A组给予鞘内吗啡200μg+罗哌卡因切口浸润,B组仅给予鞘内吗啡200μg。如NRS> 4分,肌注地佐辛5mg作为补充镇痛。观察记录术后静息、活动状态下6 h、12 h、24 h镇痛效果(NRS评分)、不良反应(瘙痒、恶心和呕吐)发生率及24小时追加镇痛药总量以及患者的满意度。结果 A组产妇术后12小时静息NRS评分低于B组,A组产妇术后6小时及12小时活动NRS评分均低于B组(P<0.05)。A组追加地佐辛总量低于B组(5.67±3.65 mg vs 7.83±3.39 mg,P<0.05)。A组产妇术后满意度较高(P<0.05),而不良反应发生率两组无统计学差异。结论剖宫产术后罗哌卡因切口浸润联合鞘内注射吗啡降低术后疼痛评分,减少术后地佐辛用量,不增加副作用的发生率,利于产妇术后早期活动。

Objective To evaluate the analgesic efficacy and side effect of incisional ropivacaine infiltration combine with intrathecal morphine after cesarean delivery under spinal anaesthesia.Methods Sixty women undergoing elective caesarean section under spinal anaesthesia were randomly divided into 2 groups using a random table(group A and group B,n = 30 each).In Group A,participants received 200 μg morphine intrathecally combine with wound site infiltration with 15 ml of 0.5% ropivacaine in each side of the surgical wound(total 30 ml).In group B,participants receive 200 μg morphine intrathecally only.Dezocine(5 mg) was injected intramuscularly as rescue analgesia when NRS score> 4.Pain scores at rest and on movement at 6,12,and 24 hours,cumulative dezocine consumption at 24 hours,the incidence of side effects(pruritus,nausea and vomiting),and patient’s satisfaction were recorded.Results Pain scores at rest in group A was lower than that in group B was at 12 hours after surgery,and movement pain scores group A were lower than those in group B at 6,12 hours after surgery(P<0.05).The amount of cumulative dezocin consumption at 24 hours in group A(5.67±3.65 mg) was less than that(7.83±3.39 mg) in group B(P<0.05).There were no significant differences between the 2 groups in the incidence of side effects(pruritus,nausea and vomiting).The patient’s satisfaction were higher in group A(P<0.05).Conclusions The application of ropivacaine wound infiltration combined with intrathecal morphine after cesarean section could decrease postoperative dezocine consumption and pain score,facilitated early postcesarean activity without increased incidence of side effects.