关节腔持续输注镇痛合剂联用丁丙诺啡透皮贴在肩关节镜手术患者术后镇痛的效果

Efficacy of combined use of articular cavity infusion of analgesic mixture and transdermal buprenorphine patch for postoperative analgesia in patients underwent shoulder arthroscopic surgery

目的观察关节腔持续输注镇痛合剂联用丁丙诺啡透皮贴用于肩关节镜术后镇痛的疗效。方法肩关节镜手术患者104例,术后均行关节腔泵注镇痛。镇痛药物:吗啡10mg+罗呱卡因150mg+生理盐水50ml;镇痛泵输注剂量2ml/h。随机分为两组:观察组54例,加用丁丙诺啡透皮贴剂,患者在术前1d于患肩对侧上臂近端三角肌处贴敷丁丙诺啡透皮贴剂,一贴剂量为5mg,至术后第6天。对照组50例,术后2~6d每日加服曲马多100mg,连续5d。采用VAS疼痛评分评估患者术后6d内静息及活动时的疼痛,记录镇痛相关不良反应发生情况。结果术后12h和24h,观察组患者静息状态的VAS疼痛评分均低于对照组(P<0.05)。术后第2~6天,观察组静息和活动时VAS疼痛评分均低于对照组(P<0.05)。镇痛期不良反应:观察组发生恶心、呕吐1例;对照组发生恶心、呕吐3例,眩晕1例。结论关节镜术后,联合应用关节腔镇痛和丁丙诺啡透皮贴具有良好的术后镇痛效果,不良反应少。

Objective To observe the analgesic efficacy and safety of combined use of articular cavity infusion of analgesic mixture and transdermal buprenorphine patch for postoperative analgesia in the patients underwent shoulder arthroscopic surgery.Methods The postoperative analgesia with intraarticular cavity pumping analgesic mixture（morphine 10mg＋ropivacaine 150mg＋normal saline50 ml,2 ml/h）was performed in 104 patients underwent shoulder arthroscopic surgery,who were assigned randomly into two groups.The patients in group A were additionally given transdermal buprenorphine 5mg patch,which attached on the deltoid muscle opposite to surgical side on the first day before operation for 7days.The patients in group B were additionally given oral tramadol 100 mg daily for 5days.Analgesic efficacy at rest and active status was evaluated by VAS pain scoring at 6,12 and 24hours and on the 2^（nd） to 6^（th） day after operation.Results The VAS pain scores at rest status at12 and 24hours after surgery were lower in group A than those in group B（P〈0.05）.The VAS pain scores at rest and active status were lower in group A than those in group B on the 2^（nd） to 6^（th） day after operation（P〈0.05）.The nausea and vomiting occurred in one case in group A and 3cases in group B,and dizziness was seen in one case in group B.Conclusion Postoperative analgesia with combined use of articular cavity infusion of analgesic mixture and transdermal buprenorphine patch attaching is effective with less adverse effects in the patients underwent arthroscopic surgery.