左旋布比卡因局部浸润缓解经皮肾镜取石术后疼痛的研究

Peritubal local anesthetic infiltration of levobupivacaine in alleviating postoperative pain in percutaneous nephrolithotomy

目的探讨经皮肾镜取石术(PCNL)结束时于经皮肾穿刺通道周围注射左旋布比卡因缓解患者术后切口疼痛的效果。方法选择2013年1月至2013年11月南京军区福州总医院接受单通道PCNL治疗的上尿路结石患者60例,随机分为实验组和对照组(各30例)。PCNL术中留置肾造瘘管后,实验组于经皮肾通道周围注射0.5%左旋布比卡因20 ml,对照组则于相同部位注射生理盐水20 ml。记录术后1 h、3 h、6 h、12 h和24 h疼痛评分(VAS),以及术后镇痛药使用情况。结果术后1 h、3 h、6 h、12 h和24 h时间点,实验组患者的平均安静VAS评分均明显低于对照组(P<0.05)。术后24 h内哌替啶使用总量实验组为480 mg,而对照组则为1250 mg。实验组患者平均哌替啶使用量和哌替啶使用率均明显低于对照组(P<0.05)。实验组发生恶心、呕吐的患者也明显少于对照组(P<0.05)。结论经皮肾通道周围注射左旋布比卡因可有效缓解PCNL术后疼痛,减少术后镇痛药需要量,从而减少了相关不良反应。

Objective To explore the analgesic efficacy of levobupivacaine infiltration into the nephrostomy tract during percutaneous nephrolithotomy （PCNL）. Metlaods From January 2013 to November 2013, 60 patients with upper urinary calculi were randomized into 2 groups （n=30）. Patients in the experiment group received infiltration of 0.5% levobupivacaine （20 ml） into the nephrostomy tract after PCNL, while patients in the control group received infiltration of saline （20 ml） in the same sites. Patients＇ visual analog scale （VAS） pain scores were recorded at 1, 3, 6, 12 and 24 hours postoperatively. The usage ofpethidine was also compared. Results The VAS pain scores at 1, 3, 6, 12, and 24 hours postoperatively in the experiment group were all lower than the control group （P 〈0.05）. The total amount of pethidine was 480 mg in the experiment group while 1250 mg in the control group. The average amount and usage rate of pethidine in the experiment group were significantly less than the control group（P〈0.05）. Fewer patients had sicchasia and/or emesis in the experiment group （P〈0.05）. Conclusion Peritubal local anesthetic infiltration of levobupivacaine can decrease pain after PCNL, and may lead to less usage of pain-killer and fewer complications.