腹腔镜胆囊切除术中腹腔内应用利多卡因与左旋布比卡因的镇痛效果比较

Compare of Lidocaine and Levobupivacaine on Analgesia in Enterocoelia in Laparoscopic Cholecystectomy

目的腹腔镜胆囊切除术(LC)中腹腔内应用局麻药可以改善术后内脏痛,但局麻药种类的选择存在着争议,因此我们比较了利多卡因与左旋布比卡因的镇痛效果。方法该试验为随机、三盲对照试验。将85例行LC的患者随机分为AB两组,A组41位患者使用20m L 1%利多卡因,B组使用20m L 0.25%左旋布比卡因。所有患者接受统一的麻醉诱导和维持方案,术后使用视觉模拟量表(VAS)和语言评估量表(VRS)评估患者在0、4、8和12h的腹痛情况。结果A组患者和B组患者在基线数据上差异无统计学意义(P>0.05)。两组患者的疼痛情况随时间都显著降低,差异有统计学意义(P<0.001)。四个时间点腹部内脏疼痛VAS和VRS评分各组间差异均无统计学意义(P>0.05)。结论利多卡因和左旋布比卡因都能安全有效地减少LC术后内脏痛,但两者镇痛效果上无差异。

Objective The use of local anesthetic in enterocoelia in laparoscopic cholecystectomy can improve postoperative visceral pain. But there is a dispute on the selection of local anesthetics. Therefore we compared the analgesia effect of lidocaine with levobupivacaine. Methods In this random triple blinding controlled trial,85 patients who received LC were randomly divided into two groups,A and B. 41 patients from A group were given 20 ml 1% lidocaine,while patients from B group received20 ml 0. 25% levobupivacaine. All patients received unified narcotic induction and maintenance plan. Visual analog scale（ VAS）and language assessment scale（ VRS） were used to assess abdominal pain at 0,4,8 and 12 h after the operation. Results There was no statistically significant difference in the baseline between patients of group A and group B（ P〉0. 05）. Two groups of patients＇ pain both significantly reduced over time,the difference was statistically significant（ P〈0. 001）. The VAS and VRS score of abdominal visceral pain at four time points had no statistically significant difference between two groups（ P〉0. 05）. Conclusion Lidocaine and levobupivacaine could reduce the visceral pain after LC safely and effectively,but there is no difference on analgesic effect between them.