利多卡因持续静脉输注对腹腔镜结直肠手术患者术后疼痛的影响

Effect of Continuous Intravenous Lidocaine Administration for Pain Control in Patients Undergoing Laparoscopic Colorectal Surgery

目的探讨术中持续静脉输注利多卡因对腹腔镜结直肠手术患者术后疼痛、阿片类药物用量及胃肠道功能恢复的影响。方法将40例择期行腹腔镜结直肠手术患者随机分为利多卡因组和对照组,每组20例。利多卡因组于麻醉诱导时给予2%利多卡因2 mg/kg静脉注射,随后持续泵注利多卡因1.5 mg·kg^(-1)·h^(-1)至手术结束。对照组以生理盐水代替利多卡因。记录术后3h、12h、72h、5 d、7 d和30 d的视觉模拟疼痛(VAS)评分、首次排气排便时间、术中及术后阿片类药物用量以及术后恶心呕吐和利多卡因毒性症状。结果术后3h、12h、72h、5 d、7 d (静息时),利多卡因组VAS评分明显低于对照组(P <0.05);术后7 d行走时和术后30 d 2组VAS评分无统计学差异。与对照组相比,利多卡因组术后阿片类药物用量明显减少,胃肠道功能恢复速度明显加快,恶心呕吐情况明显减少(均P <0.05)。2组均未见利多卡因毒性症状。结论术中持续输注利多卡因有利于减轻腹腔镜结直肠手术术后疼痛,减少阿片类药物用量,有利于胃肠道功能的恢复。

Objective To evaluate the effect of continuous intravenous lidocaine administration during surgery for short-term pain control in patients undergoing laparoscopic colorectal surgery,the postoperative use of opioid,and gastrointestinal function recovery.Methods Forty patients who underwent laparoscopic colorectal surgery were randomly assigned to lidocaine and control groups.Each group consisted of 20 patients.The lidocaine group received an intravenous injection of 2%lidocaine 2 mg/kg during induction of anesthesia,followed by continuous pumping of lidocaine 1.5 mg/(kg·h)till the end of surgery.In the control group,saline was used in place of lidocaine.The visual analogue scale(VAS),time of first defecation,amount of opioids used intraoperatively and postoperatively,postoperative nausea and vomiting,and lidocaine toxicity symptoms were recorded at 3 h,12 h,72 h,5 d,7 d,and 30 d after surgery,respectively.Results At3 h,12 h,72 h,5 d,and 7 d(at rest),the VAS scores in the lidocaine group were significantly lower than those in the control group(P<0.05).At 72 h(on walking)and 30 d after surgery,no significant differences in VAS scores were found between the two groups.In comparison with the control group,the dosage of opioids in the lidocaine group was significantly reduced(P<0.05),the recovery of gastrointestinal function was significantly faster(P<0.05),and the symptom of nausea and vomiting were significantly reduced in the lidocaine group(P<0.05).No symptoms of lidocaine toxicity were observed in either group.Conclusion Continuous intravenous lidocaine administration during surgery is beneficial for postoperative pain control after laparoscopic colorectal surgery.It can also reduce the use of opioids and accelerate the recovery of gastrointestinal function.