术前口服普瑞巴林对开腹妇科手术后左旋布比卡因局部伤口持续镇痛的影响

EFFECT OF PREOPERATIVE ORAL PREGABALIN ON POSTOPERATIVE LEVOBUPIVACAINE CONTINUOUS WOUND LOCAL ANALGESIA AFTER OPEN GYNECOLOGIC SURGERY

目的探讨术前口服普瑞巴林对开腹妇科手术后左旋布比卡因局部伤口持续镇痛的影响。方法择期开腹妇科手术病人40例,ASA分级Ⅰ或Ⅱ级,随机分为普瑞巴林组（P组）和对照组（D组）。麻醉前30min,P组病人口服普瑞巴林胶囊150mg,D组病人口服自制面粉胶囊。两组病人均行全身麻醉,常规麻醉诱导,术中静脉泵注瑞芬太尼和异丙酚,按需追加肌松药维持麻醉。两组病人术后均行5g/L左旋布比卡因局部伤口筋膜下持续输注镇痛。分别记录病人术后2、4、8、12、24h静息和活动时的疼痛VAS评分,术后补充镇痛情况,对镇痛满意率,不良反应及住院时间等。结果与D组比较,P组病人术后各时间点静息和活动时的疼痛VAS评分均明显降低（t=3.34~6.98,P〈0.05）。P组和D组术后需要哌替啶镇痛者分别为3、6例,两组在24h内补充哌替啶用量分别为（65±15）、（108±42）mg,差异有统计学意义（t=4.31,P〈0.05）。P组对镇痛满意率为90%,D组为70%,两组比较差异有统计学意义（χ^2=2.24,P〈0.05）。两组病人不良反应均较轻,两组间差异无统计学意义（P〉0.05）。两组病人住院时间比较,差异无统计学意义（P〉0.05）。结论术前口服普瑞巴林可以增强开腹妇科手术后病人5g/L左旋布比卡因局部伤口持续镇痛的效果,减少术后阿片类药物的用量,安全性高。

Objective To investigate the effect of preoperative oral pregabalin for continuous local wound analgesia with levobupivacaine after open gynecologic surgery. Methods Forty patients scheduled for elective open gynecologic surgery -ASA grade 1 or 2-were randomized to pregabalin group （group P） and control group （group D）. Thirty minutes before anesthesia, oral pregabalin capsule （150 mg） was given to patients in the group P, and those in the group D were given oral homemade flour capsules. General anesthesia was performed in patients of the two groups with routine induction. Intravenous infusion of remifentanil and propofol was given at surgery, and muscle relaxant was added as required to maintain anesthesia. After surgery, continuous infusion analgesia of 5 g/L levobupivacaine was given under wound fascia. VAS pain score when resting and active in patients after 2,4,8,12 and 24 hours of surgery, posoperative supplementary anasgesis, satisfaction rate of analgesia, adverse reactions, and hospital stay were recorded. Results Compared with group D, the pain scores of resting and active in each time point in patients of group P were lower （t=3.34-6.98,P〈0.05）. The patients in groups P and D who needed pethidine for pain relief after surgery were recorded in three and six cases, respectively, the added dosages were （65±15） and （108±42） mg in 24 hours, the difference being significant （t=4.31,P〈0.05）. The satisfaction rate of patients in group P and group D was 90% and 70%, respectively, the difference between the two groups was statistically significant （χ^2=2.24,P〈0.05）. The adverse reactions were mild in both groups, no significant differences were noted between the two groups （P〉0.05）. Conclusion Preoperative use of oral pregabalin can enhance the effect of 5 g/L levobupivacaine on continuous pain relieve of local wound with high safety after open gynecologic surgery and decrease postoperative dosage of opioids.