腹直肌鞘阻滞联合输注布托啡诺或舒芬太尼在腹腔镜胆囊切除术患者的术后镇痛效果

Postoperative analgesic efficacy of rectus sheath block combined with infusion of butorphanol or sufentanil in patients undergoing laparoscopic cholecystectomy

目的比较超声引导下腹直肌鞘阻滞(RSB)联合布托啡诺或舒芬太尼静脉输注在单切口腹腔镜胆囊切除术(SILC)患者的术后镇痛效果。方法择期SILC患者80例随机分为两组,每组40例。采用静-吸复合麻醉。术前超声引导下行0.5%罗哌卡因双侧RSB(一侧10 mL)。术中,A组患者静脉泵注布托啡诺0.02 mg·kg^(-1)·h^(-1),B组泵注舒芬太尼0.1μg·kg^(-1)·h^(-1)。术后2、6、12和24 h评估静息及咳嗽时的切口疼痛和内脏疼痛数字评价量表(NRS)评分,记录术后24 h内因明显疼痛需要额外应用镇痛药的次数,记录术中失血量、手术时间及住院时间,计算雷米芬太尼和丙泊酚消耗量,观察不良反应发生情况。结果与B组比较,A组术后2、6和12 h静息时及咳嗽时内脏疼痛NRS评分均降低(P<0.05)。A组术后24 h内额外镇痛次数少于B组(P<0.05)。两组手术时间、术中失血量、雷米芬太尼和丙泊酚消耗量以及住院时间差异均无统计学意义(P>0.05)。A组不良反应发生率低于B组(P<0.05)。结论与联合输注舒芬太尼比较,RSB联合输注布托啡诺更能有效缓解SILC患者术后内脏疼痛,减少额外镇痛的需要,降低不良反应发生率。

Objective To compare the postoperative analgesic efficacy of ultrasound-guided rectus sheath block(RSB) combined with butorphanol or sufentanil infusion in the patients undergoing single incision laparoscopic cholecystectomy(SILC).Methods Eighty patients undergoing selective SILC under intravenous-inhalation combined anesthesia were randomly divided into two groups with 40 cases each.Ultrasound-guided RSB of both sides with 0.5% ropivacaine 10 mL each was performed before surgery in both groups.During operation,butorphanol 0.02 mg·kg^(-1)·h^(-1) was infused in group A and sufentanil 0.1 μg·kg^(-1)·h^(-1) was infused in group B.The numerical rating scale(NRS) scores of incision pain and visceral pain at rest and during coughing were evaluated at 2,6,12 and 24 hours after surgery.The number of additional injection of analgesics for pain relief,intraoperative blood loss,operation time and hospital stay after operation were recorded.The consumptions of remifentanil and propofol were calculated and the occurrence of adverse responses was observed.Results Compared to group B,the NRS scores of visceral pain at rest and during coughing were less at 2,6 and 12 hours after surgery in group A(P<0.05).The number of additional injection of analgesics for pain relief was less in group A than that in group B(P<0.05).There were no significant differences in intraoperative blood loss,operation time,consumptions of remifentanil and propofol and hospital stay after operation between the two groups(P>0.05).The incidence of adverse responses was less in group A than that in group B(P<0.05).Conclusion Compared to combined infusion of sufentanil,RSB combined with infusion of butorphanol was more effective in relieving postoperative visceral pain,reducing the need for additional analgesia and reducing the incidence of adverse responses in SILC patients.