腹腔镜全子宫切除术后腹腔内喷洒罗哌卡因联合静脉自控镇痛对术后康复的影响

Effect of intraperitoneal ropivacaine spray combined with intravenous patient-controlled analgesia on postoperative rehabilitation after laparoscopic total hysterectomy

目的观察腹腔内喷洒罗哌卡因联合静脉自控镇痛(PCA)对患者腹腔镜全子宫切除术后康复的影响。方法择期行腹腔镜全子宫切除术患者80例随机分为R组和C组,每组40例。两组均采用全凭静脉麻醉,术后行芬太尼静脉PCA。R组手术结束前腹腔内均匀喷洒0.2%罗哌卡因50 mL,C组作为对照。评估术后3 h(T1)、12 h(T2)和24 h(T3)时的VAS疼痛评分,记录术后24 h内PCA按压次数。检测T3时的血清IL-6和IL-10水平。记录患者术后首次下床时间、首次排气时间及不良反应发生情况。结果与C组比较,R组术后T1、T2和T3时VAS疼痛评分和术后24 h内PCA按压次数均减少,T3时的血清IL-6水平较低,IL-10水平较高,术后首次下床时间和首次排气时间较早,术后皮肤瘙痒、眩晕的发生率降低(P<0.05)。结论腹腔内喷洒罗哌卡因联合静脉PCA能有效提高腹腔镜全子宫切除术后镇痛效果,促进患者术后康复。

Objective To investigate the effect of intraperitoneal ropivacaine spray combined with intravenous patient-controlled analgesia(PCA)on postoperative rehabilitation after laparoscopic total hysterectomy.Methods Eighty patients scheduled for elective laparoscopic total hysterectomy were randomly divided into two groups of R and C with 40 cases each.Total intravenous anesthesia was applied and intravenous PCA with fentanyl was performed after surgery in both groups.At the end of surgery,0.2%ropivacaine 50 mL was sprayed intraperitoneally in group R,which was not in group C as the control.Postoperative VAS pain scores were evaluated in the 3rd(T1),12th(T2)and 24th hour(T3)after operation.The number of PCA pressing within 24 hours after operation was recorded and serum levels of IL-6 and IL-10 at T3 were detected in the two groups.The first time of getting out of bed and having exhaust was recorded.The occurrence of adverse responses was observed.Results Compared with group C,the patients in group R had less VAS scores at T1-T3 and PCA pressing number within 24 hours after operation,lower level of IL-6 and higher level of IL-10 at T3,ealier time for the first time of getting out of bed and having exhaust,and lower incidence of skin pruritus and vertigo after operation(P<0.05).Conclusion Intraperitoneal ropivacaine spray combined with intravenous PCA is effective in attenuating the postoperative pain and promoting the recovery in the patients after laparoscopic total hysterectomy.