罗哌卡因切口浸润对肝癌患者术后镇痛及快速康复的影响

Ropivacaine wound infiltration:a fast-track approach in patients with hepatocellular carcinoma undergoing open hepatectomy

目的探讨罗哌卡因切口浸润对开腹肝癌肝切除患者术后的镇痛效果及快速康复的影响。方法本研究为随机、三盲、对照试验,选择择期行开腹肝癌肝切除术患者52例,男32例,女20例,年龄18~70岁,ASAⅠ~Ⅲ级,采用随机数字表法将患者随机分为两组,每组26例。关腹前,分别使用0.75%罗哌卡因（ROP组）或10ml生理盐水（NS组）行切口两侧局部浸润。观察并记录术后6、12、24和48h的NRS疼痛评分、总住院时间、术后住院时间、肠道恢复时间、首次下床活动时间、引流管拔除时间,以及术后肝肾功能、过敏反应、恶心呕吐及切口感染等不良反应情况。结果与NS组比较,ROP组术后6h[（3.85±1.29）分vs.（5.30±1.76）分]、12h[（3.38±0.85）分vs.（5.69±1.38）分]、24h[（3.69±0.74）分vs.（4.42±1.13）分]的NRS疼痛评分明显降低,总住院时间明显缩短[（17.92±1.97）d vs.（19.53±2.42）d],首次排气[（48.07±7.49）h vs.（53.42±10.38）h]和首次下床活动时间[（2.34±0.62）d vs.（2.80±0.84）d]明显提前（P〈0.05）。两组术后肝肾功能差异无统计学意义,均无过敏反应发生,NS组有1例（4%）切口感染和4例（15%）恶心呕吐,ROP组有5例（19%）恶心呕吐。结论罗哌卡因切口浸润能有效减轻肝癌患者术后疼痛,是一种安全有效、简单易行的快速康复措施。

Objective To investigate the effectiveness and safety of wound infiltration with ropivacaine for postoperative analgesia as a fast-track approach in patients undergoing open hepatectomy.Methods Fifty-two patients with hepatocellular carcinoma,32 males,20females,aged 18-70 years,scheduled for selective open hepatectomy were enrolled in this trible-blind,randomized,controlled study.Patients were randomized to receive 0.75% ropivacaine（group ROP）or 0.9% normal saline（group NS）wound infiltration before incision closures at a total volume of 10 ml.Numerical rating score（NRS）at 6,12,24 and 48 hours after surgery,length of hospital stay,time to bowel recovery,ambulation and drainage tube extraction were recorded.Side effects,including postoperative liver and renal function,allergic reaction,nausea and vomiting,and wound infection,were also assessed.Results NRS was significantly decreased at 6[（3.85±1.29）scores vs.（5.30±1.76）scores],12 [（3.38±0.85）scores vs.（5.69±1.38）scores]and 24hours[（3.69±0.74）scores vs.（4.42±1.13）scores]after surgery in group ROP compared to group NS（P〈0.05）.Group ROP also showed shorter postoperative hospital stays[（17.92±1.97）d vs.（19.53±2.42）d],earlier anal exsufflation[（48.07±7.49）h vs.（53.42±10.38）h]and ambulation[（2.34±0.62）d vs.（2.80±0.84）d]（P〈0.05）.However,there were no significant differences between the two groups in regarding post-operative liver and renal function.The incidence of nausea and vomiting was 15%（4cases）and 19%（5cases）in group NS and group ROP,respectively.No allergic reactions occurred in either group.Conclusion The present study shows that ropivacaine wound infiltration could effectively release post-operative pain,and could be a safe and effective fast-track approach for patients undergoing open hepatectomy.