罗哌卡因联合布托啡诺对妇科腹腔镜手术后疼痛影响的对照研究

Effects of Ropivacaine and Butorphanol on Postoperative Visceral Pain in Patients Undergoing Gynecological Laparoscopic Operations

目的：观察静脉注射布托啡诺联合腹腔内注射罗哌卡因对妇科腹腔镜手术患者术后疼痛的影响。方法将2013年9月～2014年3月80例择期在全身麻醉下行妇科腹腔镜手术患者随机分为观察组（罗哌卡因联合布托啡诺组）和对照组，每组40例。观察组术前30分钟静脉注射布托啡诺20μg／kg，并在气腹结束前向手术创面喷洒0．4％罗哌卡因5 ml，缝合皮肤前向切口局部注射0．4％罗哌卡因5 ml。对照组给予同等量生理盐水。采用视觉模拟评分（ visual analogue score，VAS）评价术后2、6、12、24 h的疼痛强度。结果术后2、6、12 h观察组的VAS均低于对照组（2 h：4．1±0．6 vs．6．8±0．8，t＝－16．419， P＝0．000；6 h：3．2±0．8 vs．7．1±1．5， t＝－14．425， P＝0．000；12 h：3．4±0．5 vs．6．2±1．9， t＝－8．733， P＝0．002），术后24 h 2组VAS差异无显著性（3．1±0．8 vs．3．2±0．7， t＝－0．723， P＝0．472）。结论布托啡诺联合罗哌卡因可显著缓解妇科腹腔镜术后疼痛，且无明显不良反应。

Objective To determine the efficacy of administration of ropivacaine and butorphanol on postoperative visceral pain relief after gynecological laparoscopic operations. Methods Between September 2013 and March 2014, 80 ASA Ⅰ -Ⅱpatients who underwent elective gynecological laparoscopic operations under general anesthesia were randomly divided into 2 groups, with 40 patients in each group.The experiment group was given 20 μg/kg butorphanol intravenously 30 min before the surgery, local spray of 0.4%ropivacaine 5 ml before removal of pneumoperitoneum, and injection of 0.4%ropivacaine 5 ml at the site of incision. The control group received sodium chloride injection.The VAS scores at 2, 6, 12, and 24 h postoperatively were assessed. Results Compared with the control group, the VAS scores were lower in the experiment group at 2, 6, 12 h postoperatively （2 h：4.1 ±0.6 vs. 6.8 ±0.8, t=-16.419, P=0.000;6 h：3.2 ±0.8 vs.7.1 ±1.5, t=-14.425, P=0.000;12 h：3.4 ±0.5 vs.6.2 ±1.9, t=-8.733, P=0.002）.However, there was no significant difference between the two groups at 24 h postoperatively （3.1 ±0.8 vs. 3.2 ±0.7, t=-0.723, P=0.472） . Conclusion Preemptive analgesia with ropivacaine and butorphanol has significant effect on postoperative pain relief after gynecological laparoscopic operations without influences on the recovery.