地佐辛复合罗哌卡因切口浸润对腹腔镜结肠癌根治术患者术后疼痛的效果

Effect of multimodal analgesia on postoperative pain in patients undergoing laparoscopic colorectal cancer resection

目的观察地佐辛复合罗哌卡因切口浸润对腹腔镜结肠癌手术患者术后疼痛的效果。方法择期腹腔镜下结肠癌手术患者90例,采用随机数字表法分为对照组(C组)、罗哌卡因组(R组)和罗哌卡因复合地佐辛组(D组),每组30例。关闭腹膜后,D组给予0.375%罗哌卡因40ml(内含地佐辛5mg)对腔镜操作孔局部浸润,R组给予0.375%罗哌卡因40ml,对照组给予0.9%氯化钠溶液40ml。对术后疼痛视觉模拟评分(VAS)、术后舒芬太尼使用量及术后血浆TNF-α水平进行分析。结果 C组术后各时点VAS评分和舒芬太尼用量较R组和D组高(P<0.05),而且术后24h时血浆TNF-α水平明显高于R组和D组;D组术后12、24h VAS评分低于R组(P<0.05);且术后12、24h镇痛泵舒芬太尼用量低于R组(P<0.05);D组在术后24h时TNF-α水平明显低于R组(P<0.05)。术后24h的血浆TNF-α水平与VAS评分呈负相关(r=-0.078,P=0.483),与PCIA舒芬太尼用量呈正相关(r=0.15,P=0.173)。结论应用地佐辛复合罗哌卡因切口浸润为基础的多模式镇痛,能提高腹腔镜下结肠癌手术患者术后镇痛效果,减轻炎性反应。

Objective To evaluate the effect of multimodal analgesia on postoperative pain in patients undergoing laparoscopic colorectal cancer operation.Methods Ninety patients with colorectal cancer undergoing elective laparoscopic resection were randomly divided into control group（group C）,ropivacaine group（group R） and ropivacaine combined with dezocine group（group D） with 30 cases in each group.After the peritoneum was closed,patients in group D received 0.375%ropivacaine 40ml（containing dezocine 5mg） for wound infiltration at the laparoscopic ports,group R received 0.375% ropivacaine40 ml,group C received 0.9% sodium chloride solution 40 ml.The visual analogue scale（VAS）,postoperative sufentanil consumption of patient-controlled intravenous analgesia（PCIA） at 4,8,12,24 h after operation were analyzed respectively.Blood samples were collected to determine plasma levels of TNF-α before induction of anesthesia,at the end of operation and 24 h after surgery.Results The VAS score and sufentanil consumption in the group C was higher than those in groups R and D（P〈0.05） at all time points after operation.The plasma TNF-α levels at 24 h after operation in group C were significantly higher than those in groups R and D（P〈0.05）.VAS and the sufentanil consumption in group D were lower than those in group R at 12 h and24h after operation（both P〈0.05）.The TNF-α level in group D at postoperative 24 h was lower than that in group R（P〈0.05）.Conclusion The application of multimodal analgesia of ropivacaine and dezocine for wound infiltration combined with basic postoperative analgesia can enhance the analgesic effect and alleviate the postoperative inflammatory reaction in laparoscopic colorectal cancer operation.