腹腔内药物注射对腹腔镜术后的镇痛作用

Analgesic Effects of Medications via Intraperitoneal Injection at the End of Laparoscopic Cholecystectomy

目的 探讨腹腔镜胆囊切除术后腹腔内注射不同局麻药行术后镇痛的效果和可行性。方法48例病人随机分成A、B、C、C四组,术毕腹腔内分别注入生理盐水20ml、2％利多卡因20ml、0.5％布比卡因20ml、0.75％罗哌卡因20ml,术后0、1、2、3、6、24h行VAS评分,VAS≥4,予吗啡1mg静脉推注,记录吗啡用量、肩背痛及术后恶心呕吐（PONV）情况,并在术前0.5h、术后3h测血浆皮质醇浓度。结果 C、D组吗啡用量小于A组（P<0.05）,D组术后3h血浆皮质醇浓度低于A组（P<0.05）,A、B组与C组间无显著性差异;各组在肩背痛、PONV方面无差异。结论腹腔镜胆囊切除术后0.75％罗哌卡因、0.5％布比卡因腹腔内注射安全、有效,罗哌卡因优于布比卡因,利多卡因作用有限。

Objective To observe the different analgesic effects of intraperitoneal injection local anesthetics at the end of laparoscopic cholecystectomy. Methods Forty - eight patients were randomly assigned into 4 groups to receive an intraperitoneal instillation of 20ml saline (group A) , 2% lidocaine (group B) , 0. 5% bupivacaine (group C) , and 0. 75% ropivacaine (group D) at the end of surgery. Postoperative pain was assessed by using a 0-10 graded visual analog scale ( VAS) every one hour within the first 6h after surgery and at 24h. Intravenous morphine 1mg was given ii VAS > 4. Postoperative nausea and vomiting (PONV) was rated on a 4-point scale. Metabolic endocrine response (blood cortisol concentration) , back and shoulder pain and analgesic requirements also were investigated. Results Pain intensity ( visual analog scale) and analgesic requirements were significantly low in groups C and D than group A. Back and shoulder pain and PONV were not improved in these groups. Blood cortisol concentration 3h after surgery were significantly less in Group D. Conclusion Intraperitoneal instillation of 0. 75% ropivacaine and 0.5% bupivacaine are safe and effective to prevent postoperative pain and 0. 75% ropivacaine can inhabit stress response.