罗哌卡因和利多卡因对椎管内分娩镇痛下自然分娩后会阴疼痛镇痛效果的比较

Comparison of analgesic effect of ropivacaine and lidocaine on perineal pain after natural delivery under intraspinal analgesia

目的 比较罗哌卡因和利多卡因浸润麻醉对椎管内分娩镇痛下自然分娩后会阴疼痛的镇痛效果。方法 回顾性分析2018年2月—2019年2月于本院产科接受椎管内分娩镇痛自然分娩的61例足月单胎产妇的临床资料,其中初产妇46例,经产妇15例。将会阴切开术或会阴修补术前接受罗哌卡因会阴浸润麻醉者设为观察组(n=33);接受利多卡因浸润麻醉者设为对照组(n=28)。比较两组患者用局部麻醉实施后1、5、30 min及第三产程结束后6 h、12 h、24 h的VAS评分以评估局麻药的镇痛效果;产后3天比较两组产妇坐立、排尿、睡觉会阴疼痛以评估产妇的产后恢复情况。结果 局麻药注药后1 min后观察组感觉无痛的产妇多于对照组(P<0.05),但是在局麻药注射5 min、30 min后两组VAS评分无明显差异(P>0.05);第三产程结束后6 h、12 h、24 h,观察组感觉无痛的产妇显著多于对照组(P<0.001);产后三天观察组坐立、排尿和睡觉感觉无痛的产妇均多于对照组(P均<0.05)。结论 罗哌卡因浸润麻醉能提供更快和更长时间的镇痛,值得在临床上推广应用。

Objective To compare the analgesic effect of ropivacaine and lidocaine infiltration anesthesia on perineal pain after natural delivery under intraspinal analgesia.Methods The clinical data of 61 full-term singleton women who underwent spontaneous labor in obstetrics department of our hospital under intraspinal analgesiafrom February 2018 to February 2019 were retrospectively analyzed, including 46 primipara and 15 multipara.The women received perineal infiltration anesthesia with ropivacaine before perineotomy or perineosynthesis were enrolled in the observation group(n=33),and those received lidocaine for perineal infiltration anesthesia were enrolled in the control group(n=28).The VAS scores at 1 min, 5 min, and 30 min after the implementation of local anesthesia and at 6 h, 12 h, 24 h after the end of the third stage of labor were compared between the two groups to evaluate the analgesic effect of local anesthetics.The perineal pain at sitting, urinating, sleeping were compared between the two groups at 3 days after delivery to evaluate the postpartum recovery.Results The number of painless parturients in the observation group was more than that in the control group at 1 min after local anesthetic injection(P < 0.05),but there was no significant difference in VAS score between the two groups at 5 min, 30 min after local anesthetic injection(P>0.05).The number of painless parturients in the observation group was significantly more than that in the control group at 6 h, 12 h, 24 h after the end of the third stage of labor(P<0.001).On the third day after delivery, the number of parturients who felt painless during sitting, urinating and sleeping in the observation group was more than that in the control group(P<0.05).Conclusions Infiltration anesthesia with ropivacaine could provide faster and longer analgesia, which is worthy of clinical application.