行走性腰麻联合冰寒散坐浴用于肛肠手术观察

Walking lumbar anesthesia combined with ice cold scattered hip bath for anorectal surgery

目的比较罗哌卡因可行走腰麻与利多卡因局麻用于肛肠手术麻醉效果的观察。方法选择美国麻醉医师协会ASAⅠ～Ⅱ级需行日间肛肠手术患者100例,按随机数字表法分为两组(n=50):实验组S组(腰麻复合冰寒散组),1%罗哌卡因2 mg,复合舒芬太尼注射液5μg,用生理盐水共稀释至4 ml行L_(3/4)椎间隙鞘内注射麻醉。S组术后行肛周冰寒散坐浴;对照组D组(局麻组)术中以1%利多卡因肛周局部浸润麻醉。观察麻醉起效时间及麻醉维持时间,术中及术后24 h、48 h的VAS评分;术后48小时内镇痛药物用量;改良Bromage运动评分;恶心呕吐等不良反应。结果 D组的麻醉起效时间明显快于S组,S组在术中、术后的VAS评分都低于D组。且D组在术后2天内镇痛药物使用量明显多于S组。两组手术结束时双下肢运动阻滞评分都为0分,可行走率都为100%。除S组出现6例皮肤瘙痒外,其余各组均未见恶心呕吐、低血压、尿潴留的发生。结论 5μg舒芬太尼复合2 mg罗哌卡因用于肛肠手术蛛网膜下腔阻滞镇痛效果好,优于局麻组,对下肢运动功能不受影响,不良反应发生率低,术后复合冰寒散坐浴能减轻术后疼痛,用于肛肠手术有一定的临床参考价值。

Objective To compare the anesthetic effect of ropivacaine and lidocaine in anal and intestinal surgery.Methods A total of 100 patients with ASA grade I-II undergoing daytime anorectal surgery were randomly divided into two groups(n=50):experimental group S(combined spinal anesthesia with Binghan Powder group),1%ropivacaine 2 mg,combined sufentanil 5 ug,diluted to 4 ml with normal saline for intrathecal injection of L3/4 spinal space anesthesia.Postoperative perianal ice-cold powder hip bath was performed in group S,and perianal infiltration anesthesia with 1%lidocaine was performed in group D(local anesthesia).The onset time of anesthesia and duration of anesthesia were observed,VAS scores at 24 hours and 48 hours after operation,dosage of analgesics within 48 hours after operation,modified Bromage motor score,nausea and vomiting were observed.Results The onset time of anesthesia in group D was significantly faster than that in group S.The VAS scores in group S were lower than that in group D during and after operation.The dosage of analgesic drugs in group D was significantly higher than that in group S within 2 days after operation.At the end of operation,the two groups had 0 lower limb motor block scores,and the feasible walking rate was 100%.No nausea,vomiting,hypotension and urinary retention were found in all groups except 6 cases of pruritus in group S.Conclusion 5 ug sufentanil combined with 2 mg ropivacaine for analgesia is better than local anesthesia group.It has no effect on lower limb motor function and low incidence of adverse reactions.