骶管阻滞复合静脉或骶管内注射地塞米松用于高位肛瘘切除术患者术后镇痛的效果

Efficacy of caudal block combined with intravenous or caudal injection of dexamethasone for postoperative analgesia in patients with high anal fistula resection

目的探讨骶管阻滞复合静脉注射地塞米松或骶管内注射地塞米松用于高位肛瘘切除术患者术后镇痛的有效性与安全性。方法选取行高位肛瘘切除术的患者63例,随机分为Ⅰ组(静脉注射地塞米松+骶管阻滞)、Ⅱ组(骶管内注射地塞米松+骶管阻滞)和Ⅲ组(单纯骶管阻滞),每组21例。Ⅰ组患者骶管内注射0.5%罗哌卡因15~20 mL,静脉注射地塞米松5 mg;Ⅱ组患者骶管内注射0.5%罗哌卡因15~20 mL+地塞米松5 mg;Ⅲ组患者骶管内注射0.5%罗哌卡因15~20 mL。采用视觉模拟评分(VAS)评估患者麻醉前、手术开始即刻及手术开始后10、20 min及手术结束即刻时的疼痛程度;比较患者出室后2、6、12、24 h的VAS评分。记录患者首次帕瑞昔布钠使用时间及帕瑞昔布钠使用人数、曲马多使用人数。记录患者术后恶心呕吐(PONV)、尿潴留、低血压发生率。结果3组患者麻醉前、手术开始即刻及手术开始后10、20 min及手术结束即刻时的VAS评分比较,差异无统计学意义(P>0.05)。Ⅲ组出室后2、6 h的VAS评分高于Ⅰ组、Ⅱ组患者,差异有统计学意义(P<0.05)。Ⅲ组患者首次帕瑞昔布钠使用时间短于Ⅰ组、Ⅱ组患者,差异有统计学意义(P<0.05);Ⅲ组患者曲马多使用人数多于Ⅰ组、Ⅱ组患者,差异有统计学意义(P<0.05)。Ⅲ组患者PONV发生率高于Ⅰ组患者,差异有统计学意义(P<0.05)。3组患者尿潴留情、低血压发生率比较,差异无统计学意义(P>0.05)。结论骶管阻滞复合静脉或骶管内注射地塞米松均能增强高位肛瘘切除术患者的术后镇痛效果,延长术后镇痛时间。骶管阻滞复合静脉注射地塞米松在预防术后恶心呕吐方面效果更佳。

Objective To investigate the efficacy and safety of caudal block combined with intravenous or caudal injection of dexamethasone for postoperative analgesia in patients with high anal fistula resection.Methods A total of 63 patients undergoing high anal fistula resection were selected and randomly divided into groupⅠ(intravenous dexamethasone+caudal block),groupⅡ(caudal injection of dexamethasone+caudal block)and groupⅢ(simple caudal block),with 21 cases in each group.Patients in groupⅠwere injected 15 to 20 mL 0.5%ropivacaine intravenously and 5 mg dexamethasone intravenously;thosein the groupⅡwere injected 15 to 20 mL 0.5%ropivacaine+dexamethasone 5 mg in sacral canal;those in the groupⅢwere injected 15 to 20 mL 0.5%ropivacaine in sacral canal.Visual Analog Scale(VAS)was used to evaluate the degree of pain before anesthesia,immediately after the operation as well as 10,20 minutes after the operation and immediately after the operation;the VAS scores of patients were compared at 2,6,12 and 24 h after leaving the room.The time of first use of parecoxib sodium and the number of users of parecoxib sodium and tramadol were recorded.The incidence of postoperative nausea and vomiting(PONV),urinary retention and hypotension were recorded.Results There were no significant differences in VAS scores between the three groups before anesthesia,immediately after surgery as well as 10,20 minutes after surgery and immediately after surgery(P>0.05).The VAS scores of the groupⅢwere significantly higher than those of the groupsⅠandⅡat 2 and 6 h after leaving the room(P<0.05).The first use time of parecoxib sodium in the groupⅢwas significantly shorter than that in the groupsⅠandⅡ(P<0.05);the number of tramadol users in the groupⅢwas significantly more than that in the groupsⅠandⅡ(P<0.05).The incidence of PONV in the groupⅢwas significantly higher than that in the groupⅠ(P<0.05).There were no significant differences in the incidence of urinary retention and hypotension among the three groups(P>0.05).Conclusion Caudal block combined with intravenous or caudal injection of dexamethasone can enhance postoperative analgesia and prolong postoperative analgesia time in patients with high anal fistula resection.Cacral block combined with intravenous dexamethasone is more effective in preventing postoperative nausea and vomiting.