利多卡因静脉泵注用于胃癌全身麻醉术后的镇痛效果

Analgesic effect of lidocaine intravenous pump for gastric cancer after general anesthesia

目的比较利多卡因静脉泵注对胃癌全身麻醉术后的镇痛效果。方法前瞻性选取2018年1月-2019年12月中国人民解放军联勤保障部队第九〇〇医院择期行全身麻醉下胃癌开腹手术的患者90例,采用随机数字表法分为利多卡因组(L组)、腹横肌平面阻滞(TAP)组(T组)和对照组(C组),每组30例。L组麻醉诱导前给予2%利多卡因负荷剂量1 mg/kg静脉输注,随后以维持剂量3 mg·kg^(-1)·h^(-1)泵注至术毕;T组气管插管后在超声引导下行TAP阻滞,以0.25%盐酸罗哌卡因每侧20 ml注入;C组给予与L组等容量生理盐水静脉输注。术后3组均采用舒芬太尼2μg/kg联合氯胺酮2 mg/kg行患者自控静脉镇痛(PCIA)。比较3组患者术后1 h(T_(1))、6 h(T_(2))、12 h(T_(3))、24 h(T_(4))、48 h(T5)疼痛视觉模拟评分(VAS)、PCIA按压次数及术后恶心呕吐(PONV)发生情况。结果L组与T组T_(1)、T_(2)、T_(3)、T_(4)、T5时点VAS评分比较差异均无统计学意义(P>0.05),L组和T组T_(1)、T_(2)、T_(3)、T_(4)时点VAS评分均低于C组(P<0.05);L组与T组PCIA次数比较差异无统计学意义(P>0.05),L组和T组PCIA次数低于C组(P<0.05);L组与T组术后48 h内PONV的发生率低于C组,但差异无统计学意义(P>0.05)。3组患者均无严重不良反应发生。结论利多卡因静脉泵注用于胃癌全身麻醉术后48 h内的镇痛效果与超声引导下TAP阻滞相当,治疗剂量无明显不良反应。

Objective To compare the analgesic effects of lidocaine intravenous pump on gastric cancer after general anesthesia.Methods From January 2018 to December 2019,90 patients who underwent elective open surgery for gastric cancer under general anesthesia at the 900 th Hospital of the Joint Service Support Force of the Chinese People’s Liberation Army were prospectively selected.Using random number table method,they were divided into lidocaine group(group L),TAP group(group T)and control group(group C),with 30 cases in each group.In group L,2%lidocaine was infused at the loading dose of 1 mg/kg before induction of anesthesia,and then the maintenance dose of 3 mg·kg^(-1)·h^(-1) was injected to the end of the operation.In group T,TAP was blocked under ultrasound guidance after endotracheal intubation,20 ml ropivacaine hydrochloride was injected subcutaneously each side.In group C,same volume of saline as the lidocaine used in group L was injected intravenously.All the three groups were treated with patient-controlled intravenous analgesia(PCIA)with sufentanil2μg/kg and ketamine 2 mg/kg.Compared the visual analogue scale(VAS)score at 1 h(T_(1)),6 h(T_(2)),12 h(T_(3)),24 h(T_(4))and 48 h(T5),PCIA pressing times,post-operative nausea and vomiting(PONV)times and occurrence of adverse reactions of three groups.Results There was no statistically significant difference in VAS scores between group L and group T at T_(1),T_(2),T_(3),T_(4),and T5(P>0.05).The VAS scores at T_(1),T_(2),T_(3),and T_(4) in group L and T were lower than those in group C(P<0.05);There was no significant difference in the number of PCIA between group L and the group T(P>0.05).The number of PCIA in group L and group T was lower than that of groupC(P<0.05);The incidence of PONV in group L and group T within 48 hours after operation was lower than that in group C,but the difference was not statistically significant(P>0.05).No serious adverse reactions occurred in the 3 groups of patients.Conclusion The analgesic effect of intravenous lidocaine infusion within 48 hours after general anesthesia for gastric cancer is comparable to that of ultrasound-guided TAP block,and there was no more adverse reaction in the treat dose.