AIM: To prospectively evaluate the effectiveness and safety of continuous wound infiltration(CWI) for pain management after open gastrectomy. METHODS: Seventy-five adult patients with American Society of Anesthesiolog...AIM: To prospectively evaluate the effectiveness and safety of continuous wound infiltration(CWI) for pain management after open gastrectomy. METHODS: Seventy-five adult patients with American Society of Anesthesiologists(ASA) Physical Status Classification System(ASA) grade 1-3 undergoing open gastrectomy were randomized to three groups. Group 1 patients received CWI with 0.3% ropivacaine(group CWI). Group 2 patients received 0.5 mg/m L morphine intravenously by a patient-controlled analgesia pump(PCIA)(group PCIA). Group 3 patients received epidural analgesia(EA) with 0.12% ropivacaine and 20 μg/m L morphine with an infusion at 6-8 m L/h for 48 h(group EA). A standard general anesthetic technique was used for all three groups. Rescue analgesia(2 mg bolus of morphine, intravenous) was given when the visual analogue scale(VAS) score was ≥ 4. The outcomes measured over 48 h after the operation were VAS scores both at rest and during mobilization, total morphine consumption, relative side effects, and basic vital signs. Further results including time to extubation, recovery of bowel function, surgical wound healing,mean length of hospitalization after surgery, and the patient's satisfaction were also recorded.RESULTS: All three groups had similar VAS scores during the first 48 h after surgery. Group CWI and group EA, compared with group PCIA, had lower morphine consumption(P < 0.001), less postoperative nausea and vomiting(1.20 ± 0.41 vs 1.96 ± 0.67, 1.32 ± 0.56 vs 1.96 ± 0.67, respectively, P < 0.001), earlier extubation(16.56 ± 5.24 min vs 19.76 ± 5.75 min, P < 0.05, 15.48 ± 4.59 min vs 19.76 ± 5.75 min, P < 0.01), and earlier recovery of bowel function(2.96 ± 1.17 d vs 3.60 ± 1.04 d, 2.80 ± 1.38 d vs 3.60 ± 1.04 d, respectively, P < 0.05). The mean length of hospitalization after surgery was reduced in groups CWI(8.20 ± 2.58 d vs 10.08 ± 3.15 d, P < 0.05) and EA(7.96 ± 2.30 d vs 10.08 ± 3.15 d, P < 0.01) compared with group PCIA. All three groups had similar patient satisfaction and wound healing, but group PCIA was prone to higher sedation scores when compared with groups CWI and EA, especially during the first 12 h after surgery. Group EA had a lower mean arterial pressure within the first postoperative 12 h compared with the other two groups.CONCLUSION : CWI with ropivacaine yields a satisfactory analgesic effect within the first 48 h after open gastrectomy, with lower morphine consumption and accelerated recovery.展开更多
目的观察罗哌卡因局部浸润超前镇痛是否可以减少小儿扁桃体、腺样体切除后对镇痛药物的使用。方法将美国麻醉医师协会(ASA)分级Ⅰ～Ⅱ级、择期行扁桃体切除术患儿80例随机分为罗哌卡因局部浸润组(R组)和对照组(C组),各40例。R组在全身...目的观察罗哌卡因局部浸润超前镇痛是否可以减少小儿扁桃体、腺样体切除后对镇痛药物的使用。方法将美国麻醉医师协会(ASA)分级Ⅰ～Ⅱ级、择期行扁桃体切除术患儿80例随机分为罗哌卡因局部浸润组(R组)和对照组(C组),各40例。R组在全身麻醉后手术开始前采用0.25%罗哌卡因行双侧扁桃体窝和根部局部浸润,C组给予同等剂量生理盐水行双侧扁桃体窝和根部局部注射。比较两组患儿术后Wang-Baker笑脸量表评分,观察并记录两组患儿术后并发症及镇痛药物使用情况。结果 R组患儿术后30、60、120、180 min Wang-Baker笑脸量评分低于C组患儿(P<0.05),但术后240 min两组Wang-Baker笑脸量表评分分别为(1.9±0.5)、(2.1±0.6)分,两组比较,差异无统计学意义(P>0.05);两组患儿中需要追加镇痛药物患儿的百分率分别为2.5%(1/40)、27.5%(11/40),两组比较,差异有统计学意义(P<0.05)。R组患儿术后恶心呕吐[15.0%(6/40)、呼吸抑制[0.0%(0/40)]、嗜睡[0.0%(0/40)]发生率低于C组[20.0%(8/40)、7.5%(3/40)、7.5%(3/40)]患儿。结论罗哌卡因局部浸润超前镇痛可减少小儿扁桃体术后镇痛药物的使用和并发症的发生。展开更多
基金Supported by Foundation of Health Department of Zhejiang ProvinceChina+3 种基金No.2011RCA207Foundation of Education Department of Zhejiang ProvinceChinaNo.Y201431914
文摘AIM: To prospectively evaluate the effectiveness and safety of continuous wound infiltration(CWI) for pain management after open gastrectomy. METHODS: Seventy-five adult patients with American Society of Anesthesiologists(ASA) Physical Status Classification System(ASA) grade 1-3 undergoing open gastrectomy were randomized to three groups. Group 1 patients received CWI with 0.3% ropivacaine(group CWI). Group 2 patients received 0.5 mg/m L morphine intravenously by a patient-controlled analgesia pump(PCIA)(group PCIA). Group 3 patients received epidural analgesia(EA) with 0.12% ropivacaine and 20 μg/m L morphine with an infusion at 6-8 m L/h for 48 h(group EA). A standard general anesthetic technique was used for all three groups. Rescue analgesia(2 mg bolus of morphine, intravenous) was given when the visual analogue scale(VAS) score was ≥ 4. The outcomes measured over 48 h after the operation were VAS scores both at rest and during mobilization, total morphine consumption, relative side effects, and basic vital signs. Further results including time to extubation, recovery of bowel function, surgical wound healing,mean length of hospitalization after surgery, and the patient's satisfaction were also recorded.RESULTS: All three groups had similar VAS scores during the first 48 h after surgery. Group CWI and group EA, compared with group PCIA, had lower morphine consumption(P < 0.001), less postoperative nausea and vomiting(1.20 ± 0.41 vs 1.96 ± 0.67, 1.32 ± 0.56 vs 1.96 ± 0.67, respectively, P < 0.001), earlier extubation(16.56 ± 5.24 min vs 19.76 ± 5.75 min, P < 0.05, 15.48 ± 4.59 min vs 19.76 ± 5.75 min, P < 0.01), and earlier recovery of bowel function(2.96 ± 1.17 d vs 3.60 ± 1.04 d, 2.80 ± 1.38 d vs 3.60 ± 1.04 d, respectively, P < 0.05). The mean length of hospitalization after surgery was reduced in groups CWI(8.20 ± 2.58 d vs 10.08 ± 3.15 d, P < 0.05) and EA(7.96 ± 2.30 d vs 10.08 ± 3.15 d, P < 0.01) compared with group PCIA. All three groups had similar patient satisfaction and wound healing, but group PCIA was prone to higher sedation scores when compared with groups CWI and EA, especially during the first 12 h after surgery. Group EA had a lower mean arterial pressure within the first postoperative 12 h compared with the other two groups.CONCLUSION : CWI with ropivacaine yields a satisfactory analgesic effect within the first 48 h after open gastrectomy, with lower morphine consumption and accelerated recovery.
文摘目的观察罗哌卡因局部浸润超前镇痛是否可以减少小儿扁桃体、腺样体切除后对镇痛药物的使用。方法将美国麻醉医师协会(ASA)分级Ⅰ～Ⅱ级、择期行扁桃体切除术患儿80例随机分为罗哌卡因局部浸润组(R组)和对照组(C组),各40例。R组在全身麻醉后手术开始前采用0.25%罗哌卡因行双侧扁桃体窝和根部局部浸润,C组给予同等剂量生理盐水行双侧扁桃体窝和根部局部注射。比较两组患儿术后Wang-Baker笑脸量表评分,观察并记录两组患儿术后并发症及镇痛药物使用情况。结果 R组患儿术后30、60、120、180 min Wang-Baker笑脸量评分低于C组患儿(P<0.05),但术后240 min两组Wang-Baker笑脸量表评分分别为(1.9±0.5)、(2.1±0.6)分,两组比较,差异无统计学意义(P>0.05);两组患儿中需要追加镇痛药物患儿的百分率分别为2.5%(1/40)、27.5%(11/40),两组比较,差异有统计学意义(P<0.05)。R组患儿术后恶心呕吐[15.0%(6/40)、呼吸抑制[0.0%(0/40)]、嗜睡[0.0%(0/40)]发生率低于C组[20.0%(8/40)、7.5%(3/40)、7.5%(3/40)]患儿。结论罗哌卡因局部浸润超前镇痛可减少小儿扁桃体术后镇痛药物的使用和并发症的发生。
