罗哌卡因腹横肌阻滞联合经皮穴位电刺激用于腹腔镜全子宫切除术的临床观察

Clinical Observation of Ropivacaine for Transverse Abdominis Plane Block Combined with Transcutaneous Electrical Acupoint Stimulation in laparoscopic Total Hysterectomy

目的 观察罗哌卡因腹横肌阻滞联合经皮穴位电刺激对腹腔镜全子宫切除术患者术后24h的镇痛效应。方法 选择择期拟行腹腔镜全子宫切除术患者60例,ASAⅠ~Ⅱ级,随机分为3组（每组20例）,A组：术前经皮穴位电刺激30min＋术毕超声引导下以0.375%罗哌卡因行双侧腹横肌阻滞,每侧20m L;B组：术毕超声引导下以0.375%罗哌卡因行双侧腹横肌阻滞,每侧20m L;C组：对照组（不予任何处理）。3组患者均采用气管插管全凭静脉麻醉,术毕均使用静脉自控镇痛（PCIA）。记录患者术后2h、6h、8h、12h、24h的静息及运动（咳嗽）VAS评分、Ramsay镇静评分、BCS舒适度评分,术后首次按压镇痛泵时间及24h内自控镇痛有效按压次数、镇痛泵24h总用药量和镇痛期间不良反应发生情况。结果术后24h内A组各时点静息和运动（咳嗽）VAS评分均低于B组和C组（P〈0.05）而BCS舒适度评分均高于B组和C组（P〈0.05）;3组术后24h内各时间点Ramsay评分均无统计学差异（P〉0.05）;3组术后首次按压镇痛泵的时间A组迟于B、C两组（P〈0.05）;自控镇痛有效按压次数A组少于B、C两组（P〈0.05）;镇痛泵24h总用药量C组大于A组和B组（P〈0.05）;镇痛期间A组发生的不良反应最少。结论 罗哌卡因腹横肌阻滞联合经皮穴位电刺激应用于腹腔镜全子宫切除术患者具有良好的镇痛效果,可提高患者舒适度且不良反应较少。

OBJECTIVE The aim of the present study was to evaluate the efficacy of ropivacaine for transversus abdominis plane block （TAPB） combined with transcutaneous electrical acupoint stimulation （TEAS） in 24 hours after laparoscopic total hysterectomy. METHODS 60 patients （ASA Ⅰ - Ⅱ ） who were electively chosen to undergo laparoscopic total hysterectomy were randomly divided into 3 groups with 20 patients in each group. Group A： TEAS for 30min preoperatively plus ultrasound-guided bilateral TAPB with 0. 375% ropivacaine 20mL on each side postoperatively. Group B：Ultrasound-guided bilateral TAPB with 0. 375% ropivacaine 20mL on each side postoperatively;Group C ：Control group （no treatment）. All groups received total intravenous anesthesia combined with tracheal intubation and all patients used patient controlled intravenous analgesia （PCIA） after surgery. The results of Visual Analogue Score （VAS） at rest and during motor （cough） stimulation, Ramsay sedation score, Bruggman comfort scale （BCS） in 2,6,8,12, and 24 hour after surgery were recorded. The time of first rescue analgesia, cumulated effective pressing numbers, cumulated narcotic requirement and the incidence of side effect in the first 24 hours afteroperation were analyzed. RESULTS Compared with group B and C, VAS score appeared to be lower and BCS score was higher in group A at each time point within 24h after operation （ P 〈 0. 05 ）. However, there was no significant difference in Ramsay score among three groups （P 〉 0. 05）. Compared with group B and C, the time of first rescue analgesia was shortened, cumulated effective pressing numbers and cumulated opioid requirement were also statistically significant decreased in Group A than in group B and group C （P 〈 0. 05 ）. Within 24h after operation, the incidence of adverse reaction wasminimal among three groups （ P 〈 0. 05 ）. CONCLUSION Ropivacaine for TAPB combined with TEAS could improve postoperative analgesia ,raise patients＇ comfort degree and alleviates postoperative adverse reactions for laparoscopic total hysterectomy.