乳腺日间手术后镇痛管理的临床观察

Clinical Observation of Analgesic Management after Daytime Breast Surgery

目的比较哪种局麻方案对乳腺日间手术后镇痛效果较好,止痛时间长。方法选取2017年3月至2018年7月我院60例择期局麻下行乳腺科日间手术患者,随机分为A、B、C三组,A组:罗哌卡因行浸润麻醉;B组:罗哌卡因+地塞米松行浸润麻醉;C组:利多卡因行浸润麻醉,术后均口服布洛芬缓释胶囊。分别记录二组患者术中局麻药不良反应情况,术后1小时、4小时、8小时、12小时、24小时的疼痛评分。结果 A、B、C三组患者术后VAS评分逐渐升高(P<0.05);术后1小时A、B、C三组疼痛评分无差别(P>0.05),无统计学意义;术后4、8、12、24小时疼痛评分C组均高于A、B两组(P<0.05);术后12、24小时疼痛评分A组均高于B组(P<0.05);C组术后24小时疼痛评分高于术后12小时(P<0.05),有统计学意义;三组患者均未发生局麻药中毒等不良反应。结论罗哌卡因+地塞米松局部浸润麻醉对于乳腺日间手术后疼痛,止痛效果好,时间长,可在无皮质激素使用禁忌证的患者中广泛使用。

Objective Comparing which local anesthesia regimen has better analgesic effect and longer analgesic time after breast day operation.Methods Sixty patients undergoing breast surgery under local anesthesia from March 2017 to July 2018 were randomly divided into three groups:group A,group B and group C.Ropivacaine was used for infiltration anesthesia;group B was used for infiltration anesthesia with ropivacaine and dexamethasone;group C was used for infiltration anesthesia with lidocaine,and ibuprofen sustained-release capsules were taken orally after operation.The adverse reactions of local anesthetics during operation,pain scores during operation,1 hour,4 hours,8 hours,12 hours and 24 hours after operation were recorded respectively in the two groups.The adverse reactions of the two groups were less and the analgesic effect was better.Results The VAS scores of patients in group A,B and C increased gradually(P<0.05).There was no difference in pain scores in group A,B and C at 1 hour after operation(P>0.05).There was no statistical significance.The pain scores of 8,12,and 24 hours were higher in group C than in group A and B(P<0.05).The pain scores in group A and group 24 were higher than those in group B(P<0.05).The 24-hour pain score was higher than 12 hours after surgery(P<0.05),which was statistically significant.Conclusion Ropivacaine+dexamethasone local infiltration anesthesia has a good analgesic effect and a long time for pain after breast day operation.It can be widely used in patients without contraindication of corticosteroid use.