曲马多复合罗哌卡因臂丛神经阻滞对全麻肩关节镜手术患者术后镇痛效果的影响

Effect of tramadol combined with ropivacaine brachial plexus block on postoperative analgesia in patients undergoing arthroscopic shoulder surgery under general anesthesia

目的:探讨肩关节镜手术患者臂丛神经阻滞中使用曲马多复合罗哌卡因对术后镇痛的影响。方法:将行肩关节镜手术的患者105例随机分为对照组(52例)和观察组(53例)。两组全麻前均实施臂丛神经阻滞,其中对照组予以0.3%罗哌卡因,观察组予以0.3%罗哌卡因+曲马多100 mg。两组术后均予以自控镇痛。比较两组术后4、8、12、24 h疼痛评分,术后24 h镇痛泵有效按压次数以及补救镇痛率。比较两组术后24 h时15项恢复质量评估表(QoR-15)评分和肩关节活动度。于术前和术后24 h,对患者血清C-反应蛋白(CRP)、白细胞介素-6(IL-6)水平进行测定。统计两组术后24 h不良反应情况。结果:相较于对照组,术后各时间点观察组VAS评分更低,且术后24 h观察组镇痛泵有效按压次数更少(均P<0.05)。两组补救镇痛率比较无统计学差异(P>0.05)。相较于对照组,观察组术后24 h QoR-15评分更高,且肩关节前屈活动度和外展活动度均更大(均P<0.05)。相较于术前,术后24 h两组血清CRP和IL-6水平升高,且观察组低于对照组(均P<0.05)。相较于对照组,术后24 h不良反应观察组发生率更低(P<0.05)。结论:肩关节镜术行臂丛神经阻滞时使用曲马多复合罗哌卡因可提供较好镇痛效果,缓解患者术后疼痛,减轻炎症,改善肩关节活动度。

Objective:To investigate the effect of tramadol combined with ropivacaine for brachial plexus block on postoperative analgesia in patients undergoing arthroscopic shoulder surgery under general anesthesia.Methods:A total of 105 patients undergoing shoulder arthroscopy were randomly divided into control group(52 cases)and observation group(53 cases).Brachial plexus block was performed in both groups before general anesthesia.The control group was given 0.3%ropivacaine,and the observation group was given 0.3%ropivacaine and tramadol 100 mg.Both groups were given patient-controlled analgesia after operation.The pain scores at 4,8,12,24 hours after operation were compared between the two groups.The effective pressing times of analgesia pump at 24 hours after operation were recorded,and the remedial analgesia rate was counted.The QoR-15 score and shoulder mobility were compared between the two groups at 24 hours after operation.The serum levels of CRP and IL-6 were measured before and 24 hours after operation.The adverse reactions of the two groups at 24 hours after operation were counted.Results:Compared with the control group,the pain score of the observation group was lower at each time point after operation,and the effective pressing times of the analgesic pump in the observation group was less than that in the control group(all P<0.05).There was no significant difference in the rate of remedial analgesia between the two groups(P>0.05).Compared with the control group,the QoR-15 score of the observation group was higher at 24 hours after operation,and the flexion and abduction activities of the shoulder joint were larger(all P<0.05).Compared with pre-operation,at 24 hours after operation,the levels of serum CRP and IL-6 in the two groups increased,but those in the observation group were lower than those in the control group(all P<0.05).The incidence of adverse reactions at 24 hours after operation was lower in the observation group than that in the control group(P<0.05).Conclusion:Tramadol combined with ropivacaine for brachial plexus block in shoulder arthroscopy can provide better analgesic effect,relieve postoperative pain,reduce inflammation and improve shoulder mobility.