罗哌卡因联合氢吗啡酮连续TAP阻滞在肾移植术后镇痛中的应用

Postoperative Pain Control of Continuous TAP Blockade with Ropivacaine Combined with Hydromorphone for Patients after Renal Transplantation

目的探讨罗哌卡因联合氢吗啡酮连续TAP阻滞在肾移植术后镇痛的可行性。方法 60例行肾移植术患者,随机分为4组,每组15例。A组:单纯行术后硬膜外自控镇痛(PCEA),L1/2穿刺置管,300 mg罗哌卡因加生理盐水稀释至275 mL,实验剂量3 mL,持续输注量5 mL/h;B组:超声腹横肌平面穿刺置管,300 mg罗哌卡因;C组:超声腹横肌平面穿刺置管,300 mg罗哌卡因加氢吗啡酮2 mg;D组:超声腹横肌平面穿刺置管,300 mg罗哌卡因加氢吗啡酮4 mg,B组、C组和D组的药物均加生理盐水稀释至275 mL,负荷量3 mL,持续输注量5 mL/h。记录4组术后不同时间点VAS疼痛评分、Ramsay镇静评分、48 h内PCA的按压次数、静脉补救性镇痛药的总量及不良反应情况。结果 B、C组术后不同时间点VAS评分较A组和D组高,差异有统计学意义(均P<0.05);D组各时间点VAS疼痛评分与A组接近,差异无统计学意义(均P>0.05);D组48 h内自控镇痛(PCA)按压次数、静脉补救性镇痛剂的总量明显小于B、C组,差异有统计学意义(均P<0.05),B、C、D组术后总的不良反应明显低于A组,差异有统计学意义(均P<0.05)。结论罗哌卡因联合氢吗啡酮连续TAP阻滞可以用于肾移植术后镇痛。

Objective To investigate the effect of continuous TAP blockade with ropivacaine and hydromorphone for postoperative pain control in patient after renal transplantation.Methods Sixty patients with renal transplantation were randomly divided into four groups:group A,epidural catheter inserted at L1/2 for postoperative pain control with 300 mg ropivacaine diluted to 275 mL,and the experimental dose was 3 mL and the continuous infusion volume was 5 mL;group B,group C group D,epidural catheter inserted at ultrasound-guided transversus abdominis plane for postoperative pain control with 300 mg ropivacaine(group B),300 mg ropivacaine and hydromorphone 2 mg(group C),and 300 mg ropivacaine and hydromorphone 4 mg(group D).Ropivacaine in group B,C and D was diluted into 275 mL,load 3 mL,and continuous infusion flow 5 mL/h.The VAS pain score,Ramsay sedation score,the frequency of controlled analgesia(PCA)presses within 48 h,the total amount of intravenous remedial analgesic,and the adverse reactions were recorded at the indicated time points after operation.Results The VAS scores were higher in group B and group C than in group A and group D(P<0.05).The VAS pain scores of group D were similar to those in group A at each time point.The difference was not statistically significant(P>0.05).The total frequency of PCA presses and venous remedial analgesic in group D was significantly lower than those in group B and C within 48 h and the difference was statistically significant(P<0.05).The incidence of total adverse reactions in group D was significantly lower than that in group A and the difference was statistically significant(P<0.05).Conclusion Ropivacaine combined with hydromorphone for continuous TAP block can be used for analgesia after renal transplantation.