妇科下腹部切口不同部位持续灌注罗哌卡因对术后镇痛效果的影响

Effect of continuous infusion of ropivacaine in different parts of lower abdominal incision of gynecology on postoperative analgesia

目的 探讨妇科下腹部切口不同部位持续灌注罗哌卡因对术后镇痛效果的影响.方法 选取就诊于西北妇女儿童医院妇二科拟行经腹手术的70例患者,根据电脑随机数字法将其分为鞘膜上组(35例,鞘膜上灌注0.35%罗哌卡因)和鞘膜下组(35例,鞘膜下灌注0.35%罗哌卡因).比较两组术后不同时间的静息及动态VAS评分、不良反应、术后恢复及切口愈合情况.结果 术后12、24、48 h,鞘膜下组的静息及动态VAS评分均明显低于鞘膜上组(P<0.05).两组患者的不良反应、术后恢复及切口愈合情况比较,差异均无统计学意义(P>0.05).结论 鞘膜下持续灌注麻醉可以避免麻药外渗,使麻药充分作用于腹部痛觉神经,术后镇痛效果优于鞘膜上持续灌注麻醉,且安全性高.

Objective To explore the effect of continuous infusion of ropivacaine in different parts of lower abdominal incision of gynecology on postoperative analgesia.Methods A total of 70 patients who were going to have abdominal surgery in the No.2 gynecology department of northwest women's and childrens'hospital were selected.According to the method of computer random number,the patients were divided into upper tunica vaginalis group(35 cases,perfusion of 0.35%ropivacaine on the tunica vaginalis)and lower tunica vaginalis group(35 cases,perfusion of 0.35%ropivacaine under the tunica vaginalis).The rest and dynamic VAS scores at different times after operation,adverse reactions,postoperative recovery and wound healing were compared between the two groups.Results At 12,24 and 48 hours after operation,the rest and dynamic VAS scores in the lower tunica vaginalis group were significantly lower than those in the upper tunica vaginalis group(P<0.05).There were no significant differences in adverse reactions,postoperative recovery and wound healing between the two groups(P>0.05).Conclusion Continuous perfusion anesthesia under the tunica vaginalis can avoid extravasation of anesthetics and make the anesthetics fully act on the abdominal pain sensory nerves,has better postoperative analgesic effect than continuous perfusion anesthesia on the tunica vaginalis,and it is highly safe.