罗哌卡因切口浸润联合羟考酮静脉输注对剖宫产术后宫缩痛和早期恢复的影响

Effect of using oxycodong compound with wound infiltration with ropivacaine on uterine contraction-induced pain and early recovery after cesarean section

目的观察罗哌卡因切口浸润联合羟考酮静脉术后镇痛对剖宫产术后宫缩痛和产妇早期恢复的影响。方法择期行剖宫产手术产妇60例,年龄22~35岁,ASAⅠ或Ⅱ级,随机均分为三组:羟考酮组(O组),罗哌卡因组(R组)和羟考酮联合罗哌卡因组(OR组)。O组患者于手术缝皮前静脉注射羟考酮0.1 mg/kg,R组患者于手术缝皮前皮下注射0.5%罗哌卡因15 ml浸润麻醉,OR组患者于手术缝皮前静脉注射羟考酮0.1 mg/kg联合皮下给予0.5%罗哌卡因15 ml浸润麻醉。术后VAS评分>4分者静脉注射曲马多50 mg作为补救镇痛。比较三组产妇术后4、8、16、24、48 h的切口痛和宫缩痛的VAS评分和Ramsay镇静评分、术后48 h曲马多补救镇痛例次、术后恢复情况、术后皮肤瘙痒和恶心呕吐等不良反应发生情况。结果术后16、24 h O组和OR组宫缩痛VAS评分明显低于R组(P<0.05),O组和R组切口痛VAS评分明显高于OR组(P<0.05),术后曲马多补救镇痛例次明显大于OR组(P<0.05)。O组和R组恶心呕吐发生率明显高于OR组(P<0.05)。三组其他不良反应和术后恢复情况差异无统计学意义。结论剖宫产手术应用羟考酮静脉术后镇痛联合罗哌卡因切口浸润为基础的多模式镇痛,能对产妇的切口痛和宫缩痛达到良好的镇痛效果,其中羟考酮在减轻宫缩痛方面作用明显,且不增加术后不良反应。

Objective To observe the effect of using oxycodong compound with wound infiltration with ropivacaine on uterine contraction-induced pain and early recovery after cesarean section. Methods Sixty parturients undergoing cesarean section, aged 22-35 years, ASA Ⅰ or Ⅱ, were randomly divided into three groups: oxycodong group(group O), ropivacaine group(group R) and oxycodong combined with ropivacaine group(group OR). Parturients in group O were injected intravenously oxycodong 0.1 mg/kg beforesuture. Parturients in group R were taken 0.5% ropivzcaine 15 ml infiltration anesthesia before suture. Parturients in group OR were received intravenously oxycodong 0.1 mg/kg and 0.5% ropivzcaine 15 ml infiltration anesthesia before suture. The parturients with VAS score > 4 were given tramadol 50 mg intravenously as a remedy for analgesia. Visual analogue scale(VAS) of wound pain and uterine contraction-induced pain and Ramsay sedation score were assessed for the patients at 4, 8, 16, 24, and 48 h after administration. The 48 h tramadol consumption, early recovery, adverse effects were also recorded. Results The uterine contraction-induced pain scores of parturients were significant higher in group R than in group O and group OR at 16 and 24 h after operation(P<0.05). The VAS score of wound pain at 16 and 24 h and tramadol consumption after operation in group OR were lower than those in group O and group R(P<0.05). The incidence of PONV in group O and group R was higher than that in group OR(P<0.05). There was no significant difference in other adverse reactions and early recovery among the three groups. Conclusion The application of multimodal analgesia of intravenous analgesia with oxycodong compound with wound infiltration with ropivacaine is not only effective for wound pain scores, but also can decrease uterine contraction-induced pain with less adverse effect in patients underwent cesarean section. Oxycodong play a crucial role in suppressing uterine contraction-induced pain without increasing postoperative adverse reactions.