利多卡因局部浸润对显微耳外手术患者术中出血及术后疼痛的影响

The Effect of Lidocaine Local Infiltration on Intraoperative Bleeding and Postoperative Pain in Patients with Microsurgery Outer Ear Surgery

目的:评估2%利多卡因局部浸润对于术后疼痛缓解及术中出血的影响,探讨2%利多卡因局部浸润在全麻下显微耳外手术中的作用。方法:采用双盲法,前瞻性随机对照比较,择期因患慢性化脓性中耳炎(chronic serous otitis media,CSOM)需行全麻下显微耳外手术的患者40例,采用随机数字表法将其分成对照组(C组)和利多卡因组(L组),每组20例。C组患者采用1∶200 000肾上腺素+0.9%氯化钠溶液中局部浸润,利多卡因组(L组)患者采用1∶200 000肾上腺素+2%利多卡因局部浸润,两组患者采用相同麻醉方式和药物。采用Boezaart的分级系统进行评估术中出血。采用视觉模拟评分评估患者术后疼痛,分别于术后1 h、4 h及24 h记录两组患者疼痛评分。结果:两组患者的手术时间、丙泊酚和瑞芬太尼用量比较差异均无统计学意义(P>0.05)。L组患者术中出血量(220±15)m L明显少于C组的(400±10)m L,差异有统计学意义(P<0.05);C组中有55%患者术中出血评分为Ⅲ级,L组仅为35%,组间比较差异有统计学意义(P<0.05)。L组患者术后VAS评分(2.5±0.3)分明显低于C组的(5.5±0.3)分,C组和L组术后1 h VAS评分≥4分的患者分别为15例、10例,术后1 h VAS评分<4分的患者分别为5例、10例,组间比较差异有统计学意义(P<0.05),两组术后4 h及24 h VAS评分比较差异均无统计学意义(P>0.05)。结论:2%利多卡因局部浸润能明显减少术中出血及术后1 h疼痛,对于术后4 h及24 h疼痛减轻无明显作用。

Objective：To evaluate the effect of 2% Lidocaine infiltration on intraoperative bleeding and postoperative pain in patients with microsurgery outer ear surgery under general anesthesia.Method：Using double-blind,prospective randomized comparison,forty patients with chronic serous otitis media who underwent microsurgery outer ear surgery under general anesthesia in our hospital were selected and divided into the control group（group C） and the Lidocaine group（group L） according to the random number table method,20 cases in each group.The control group was given 1∶200 000 Epinephrine and normal saline for local infiltration,the Lidocaine group was given 1∶200 000 Epinephrine and 2% Lidocaine for local infiltration.Patients of the two groups were given the same anesthesia methods and drugs,the intraoperative bleeding was evaluated by Boezaart classification system,postoperative pain was evaluated by visual analog scale（VAS）.The VAS scores at the time point of 1 hour,4,24 hours after surgery.Result：There were no statistically significant differences in the operation time,the dosage of Propofol and Remifentanil between the two groups（P〉0.05）.The intraoperative bleeding of the group L was（220±15）m L,which was significantly less than（400±10）m L of the group C,there were 55% patients with bleeding score of Ⅲ grade in the group C,there were 35% patients with bleeding score of Ⅲ grade in the group L,the differences were statistically significant（P〈0.05）.The postoperative VAS score in the group L was（2.5±0.3）points,which was significantly less than（5.5±0.3）points of the group C,patients with VAS score ≥4 at 1 hour postoperative in the group C and group L were 15 cases and 10 cases,and the patients with VAS score 〈4 at 1 hour postoperative in the group C and the group L were 5 cases and 10 cases,the differences were statistically significant（P〈0.05）.There were no statistically significant differences in VAS scores at 4 hours and 24 hours postoperative between the two groups（P〉0.05）.Conclusion：2% Lidocaine local infiltration can reduce intraoperative bleeding and postoperative pain in 1 hour,but have no effects on pain 4 hours and 24 hours postoperative.