术前采用0.25%罗哌卡因行切口浸润麻醉对接受颅骨修补患者术后疼痛的影响

Effect of 0.25% ropivacaine wound infiltration anesthesia on postoperative pain in patients undergoing cranioplasty

目的评估术前采用0.25%罗哌卡因行切口浸润麻醉对接受颅骨修补患者术后疼痛的影响。方法择期行颅骨修补术患者40例,ASAⅠ~Ⅱ级,随机分为A和B组,A组采用自控静脉镇痛(PCIA)进行术后镇痛,B组采用0.25%罗哌卡因切口浸润联合PCIA,两组患者术毕前30 min给予舒芬太尼0.15μg/kg静脉推注后接静脉镇痛泵,镇痛的配方为舒芬太尼2μg/kg+格拉司琼6 mg+生理盐水至100 mL。记录两组患者不同T0(术毕)、T1(术后4 h)、T2(术后12 h)、T3(术后24 h)和T4(术后48 h)时间点的HR、MAP和SpO2;记录两组患者T0、T1、T2、T3和T4不同时间点的疼痛VAS评分;记录两组PCIA泵的按压次数与镇痛满意度;观察两组恶心、呕吐等不良反应的发生情况。结果与A组相比,T1、T2、T3时B组的疼痛VSA评分明显较低,差异有统计学意义(P<0.05);与B组比较,A组PCIA按压次数明显增加(P<0.05);与A组比较,B组患者镇痛满意度明显提高(P<0.05);A、B两组患者不良反应比较差异无统计学意义。结论术前采用0.25%罗哌卡因行切口浸润麻醉可以减轻颅骨修补患者术后的切口疼痛,促进患者的恢复。

Objective To evaluate the effect of 0.25%ropivacaine wound infiltration anesthesia on postoper⁃ative pain in patients undergoing cranioplasty.Methods Forty ASA I-Ⅱpatients about to receive cranioplasty were randomly divided into Group A and Group B.Patient⁃controlled intravenous analgesia(PCIA)were used in Group A,and 0.25%ropivacaine wound infiltration combined with PCIA were used in Group B.Patients in both groups were given sufentanil 0.15μg/kg intravenously 30 minutes before the end of the operation and then received intrave⁃nous analgesia pump.The analgesia formula was sufentanil 2μg/kg plus granisetron 6 mg and normal saline to 100 mL.HR,MAP and SpO2 at different times(T0,after surgery;T1,4 h after surgery;T2,12 h after surgery;T3,24 h after surgery;T4,48 h after surgery)were recorded.VAS scores at T0,T1,T2,T3 and T4 were recorded.The PCIA pump compressions and analgesic satisfaction of the two groups were recorded.Adverse reactions such as nausea and vomiting were observed in the two groups.Results The VAS scores of Group B at T1,T2 and T3 were significantly lower compared with Group A,with statistically significant difference(P<0.05).The PCIA pump compressions in Group A increased significantly compared with Group B(P<0.05).Compared with group A,patients in Group B had significantly higher satisfaction with analgesia(P<0.05).There was no significant difference in adverse reactions between Group A and Group B.Conclusion Preoperative wound infiltration anesthesia with 0.25%ropivacaine could alleviate postoperative incision pain and promote recovery of patients undergoing cranioplasty.