地塞米松联合罗哌卡因用于超声引导下腹横肌平面阻滞在腹股沟疝术后镇痛中的应用

Application of dexamethasone combined with ropivacaine under ultrasound-guided transversus abdominis plane block in postoperative analgesia of inguinal hernia

目的:探讨地塞米松联合罗哌卡因用于超声引导下腹横肌平面阻滞在腹股沟疝修补术患者镇痛中的应用。方法:选取医院实施腹股沟无张力疝修补术的370例患者,以随机数表法将其分为观察组和对照组,每组185例,对两组患者在腰麻基础上实施超声引导下腹横肌平面阻滞,对照组注射0.25%盐酸罗哌卡因20 ml镇痛,观察组注射0.25%盐酸罗哌卡因20 ml+地塞米松8 mg镇痛。采用视觉模拟量表(VAS)评分评估两组患者术后6 h、12 h、24 h及48 h疼痛程度及不良反应发生率,并统计术后首次按压镇痛泵时间、镇痛药物使用量、下床时间及住院时间。结果:术后6 h、12 h、24 h及48 h观察组患者静息VAS评分及运动VAS评分均低于对照组,差异有统计学意义(t_(静息VAS评分)=4.785,t=7.906,t=14.869,t=4.248;t_(运动VAS评分)=6.287,t=4.518,t=13.838,t=2.404;P<0.05);观察组患者恶心及感觉异常发生率低于对照组患者,差异有统计学意义(χ^(2)=4.260,χ^(2)=4.751;P<0.05)。其余不良反应两组间比较差异无统计学意义。观察组患者首次按压镇痛泵时间晚于对照组患者,镇痛泵按压次数、下床时间及住院时间均少于对照组,差异有统计学意义(t=5.214,t=7.538,t=7.319,t=9.521;P<0.001)。结论:地塞米松联合罗哌卡因用于超声引导下腹横肌平面阻滞有助于减轻腹股沟疝修补术患者术后疼痛,减少术后镇痛药物的使用,并降低不良反应发生率。

Objective:To investigate the application of dexamethasone combined with ropivacaine under ultrasound-guided transversus abdominis plane block in the analgesia of patients undergoing inguinal hernia repair.Methods:370 patients who underwent tension-free inguinal hernia repair were selected.They were divided into observation group(n=185)and control group(n=185)by random number method.On the basis of spinal anesthesia,the two groups were subjected to ultrasound-guided transversus abdominis plane block.The control group was injected with 20 ml 0.25%ropivacaine hydrochloride for analgesia,and the observation group was injected with 20 ml 0.25%ropivacaine hydrochloride+8 mg dexamethasone for that.The visual analog scale(VAS)score was used to assess the pain degree and the incidence of adverse reactions in two groups at 6th h,12th h,24th h and 48th h after surgery.The time of pressing the analgesic pump for the first time after surgery,the amount of using analgesic medicine,the time of getting out of bed and the length of hospitalization were also counted by statistical method.Results:The resting VAS scores and exercise VAS scores of observation group were significantly lower than those of control group at the 6th h,the 12th h,the 24th h and the 48th h after surgery,and the differences of them between two groups were statistically significant(t=4.785,t=7.906,t=14.869,t=4.248,t=6.287,t=4.518,t=13.838,t=2.404,P<0.05).The incidences of nausea and paresthesia of observation group were significantly lower than those of control group,and the differences of them between two groups were statistically significant(χ^(2)=4.260,χ^(2)=4.751,P<0.05).And there were no statistical differences in other adverse reactions between the two groups.The time of pressing the analgesic pump for the first time after surgery in observation group was significantly later than that in control group,and the frequency of pressing the analgesic pump,the time of getting out of bed and the length of hospitalization of observation group were significantly less than those of control group(t=5.214,t=7.538,t=7.319,t=9.521,P<0.001).Conclusion:The use of dexamethasone combined with ropivacaine under ultrasound-guided transversus abdominis plane block contributes to relieve postoperative pain of patients undergoing inguinal hernia repair,and reduce the use of postoperative analgesics and decrease the incidence of adverse reactions.