利多卡因复合芬太尼用于成人鞍区手术骶管阻滞的麻醉及镇痛效果分析

Analysis of the effect of lidocaine and fentanyl for the anesthetic and analgesic in adult sellar operation sacral block

目的：分析比较不同剂量利多卡因复合芬太尼在成人鞍区手术骶管阻滞中的麻醉和镇痛效果。方法分析我院自2012年1月～2014年4月收治的行肛门、会阴部手术的患者102例，均行鞍区手术且给予成人骶管阻滞麻醉。102例患者随机分为治疗组54例与对照组48例。对照组给予1.5％的利多卡因20～25mL，治疗组给予1.5％的利多卡因10～15mL。观察两组麻醉效果、术后24h内VAS评分及副反应。结果两组麻醉起效时间、维持时间、痛觉消失时间比较差异无统计学意义（P＞0.05）；两组患者术2h的VAS评分比较差异有统计学意义（P＜0.05），术后4、8、16、24h的VAS评分比较差异无统计学意义（P＞0.05）；两组患者呼吸抑制、恶心呕吐、尿潴留等不良反应发生率比较差异有统计学意义（P＜0.05），麻醉阻滞不全、血压降低发生率比较差异无统计学意义（P＞0.05）。结论小剂量利多卡因复合芬太尼与大剂量利多卡因组比较，不影响麻醉效果，对与术后VAS评分也无显著影响，不增加镇痛药的应用，且减少不良反应的发生，有临床推广应用的价值。

Objective To analyze and compare the different doses of lidocaine and fentanyl in anesthesia and analgesia effect of block in the sellar region sacral surgery in adults.Methods 102 cases of anus and perineal operation in our hospital from 2012 January to 2014 April received operation of sellar region and gave the adult sacral anesthesia. 102 patients were randomly divided into treatment group 54 cases and control group of 48 cases. The control group was given 1.5% lidocaine 20 to 25mL, the treatment group was given 1.5% lidocaine 10 to 15mL.The effect of anesthesia, the VAS score after 24h and side reaction of two groups were observed.Results The onset time of anesthesia, the maintain time, pain free time of two groups was not significant （P〉0.05）. The VAS scores in 2h were statistically significant （P0.05）. The adverse reactions of respiratory depression, nausea and vomiting, urinary retention of two groups were significant difference（P0.05）.Conclusion A small dose of lidocaine and fentanyl compared with large dose of lidocaine group, does not affect the effect of anesthesia, also had no significant effect on the score and postoperative VAS, not to increase the application of analgesics, and reduce the incidence of adverse reactions, has clinical application value.