下颌骨正颌术后下牙槽神经阻滞麻醉联合帕瑞昔布钠静脉镇痛的临床观察

Clinical observation of inferior alveolar nerve block combined with parecoxib sodium intravenous analgesia af ter mandible orthognaxillary surgery

目的比较正颌手术术后镇痛中,双侧下牙槽神经阻滞麻醉联合帕瑞昔布钠静脉镇痛与单纯静脉镇痛泵的镇痛效果及安全性。方法选择行下颌升支矢状骨劈开术+颏成型术的患者40例,使用随机数字表随机分成观察组和对照组,每组20例,观察组患者采用双侧各2mL 1%罗哌卡因术中下牙槽神经阻滞麻醉,术毕立即予以40 mg帕瑞昔布钠静脉注射,对照组术毕予以静脉自控镇痛泵镇痛。记录两组患者术后2、4、8、24、48 h疼痛强度(VAS疼痛评分)及Ramsay镇静评分,并观察患者术后不良反应的发生情况。结果两组患者术后各时间点疼痛强度、Ramsay镇静评分比较差异无统计学意义(P>0.05)。镇痛治疗期间,观察组患者恶心呕吐的发生率低于对照组(P<0.05)。结论双侧下牙槽神经阻滞联合帕瑞昔布钠静脉镇痛与单纯静脉镇痛泵用于下颌骨正颌手术术后镇痛效果相当,但前者不良反应发生率较低,更适用于下颌骨正颌手术术后镇痛。

Objective To compare the analgesic effect and safety of bilateral inferior alveolar nerve block com bined with parecoxib sodium analgesia and simple intravenous analgesia pump in analgesia after orthognathic surgery.Methods Forty patients with simple ascending sagittal split osteotomy and ankle plasty were randomly divided into the experimental group and the control group,with 20 patients in each group.The experimental group received 2 mL 1%ropivacaine by inferior alveolar nerve block anesthesia on both sides.Immediately after surgery,parecoxib sodium 40 mg was intravenously administered.The control group was given an intravenous analgesia pump for analgesia.Pain intensity(VAS pain score)and Ramsay sedation score were recorded at 2 h,4 h,8 h,24 h,48 h after operation,and the incidence of postoperative adverse reactions was observed.Results There was no significant difference in pain intensi ty and Ramsay sedation score between the two groups at each time point(P>0.05).During the analgesic treatment,the incidence of nausea and vomiting in the experimental group was significantly lower than that in the control group(P<0.05).Conclusion Bilateral inferior alveolar nerve block combined with parecoxib sodium analgesia and simple intra venous analgesia pump are effective for analgesia after mandibular orthognathic surgery,but the former has a lower inci dence of adverse reactions,more suitable for analgesia after mandibular orthognathic surgery.