腹膜内注射罗哌卡因对腹腔镜胆囊切除术后疼痛的缓解作用

目的：观察腹腔镜胆囊切除术后腹膜内注射罗哌卡因对术后疼痛的缓解作用。方法：采用随机、安慰剂对照和双盲的研究方法，将40名择期行腹腔镜胆囊切除术(LC)的病人随机分为两组：术后腹膜内分别注射0．75％罗哌卡因(实验组)和生理盐水(对照组)。各时段镇痛效果采用10cm视觉模拟评分法(VAS)间接评估。记录两组病人术后阵痛剂的需要量并观察比较两组病人围手术期肺功能及不良反应等。结果：术后各时段实验组病人VAS评分明显小于对照组(P<0.05)。实验组病人术后仅两人各肌注度冷丁1次，对照组有14人次术后使用度冷丁(P<0．05)。两组病人在围手术期肺功能及恶心、呕吐等方面差异无显著性。结论：LC术后腹膜内注射罗哌卡因具有良好的镇痛效果。

Introperitoneal ropivacaine after laparoscopic cholecystectomy can effectively relieve pain

Objective To evaluate whether introperitoneal ropivacaine after laparoscopic cholecystectomy(LC)could reduce pain,and observe the influence of ropivacaine on pulmonary function,postoperative nausea,vomiting, et al. Methods Forty patients underwent elective LC because of benign disease of gallbladder were randomly divided into two groups equally:group A(n=20)introperitoneal 0.75%ropivacaine 20 mL after LC,while group B(n=20)0.9%normal saline 20 mL. The detailed injection volume was given as follow. 4 mL in each of the three trocar regions,8 mL in the epigastric region.The introabdominal pressure is less than 13 mmHg during operation.Pain score was assessed using a visual analog scale(VAS)2,4,8,24,48 hours after surgery.The peak expiratory flow was recorded preoperatively and 2 hours after surgery.The additional dolantin consumption after surgery and postoperative nausea,vomiting were also recorded.The whole study was performed double blinded. Results The pain score of group A is less than group B significantly at vary time after surgery(P< 0.05). 2 patients in group A consumed dolantin,significantly less than group B(14 patients). No influence had happened about ropivacaine on peak expiratory flow,postoperative nausea, or vomiting.Conclusion Introperitoneal 0.75%ropivacaine after LC can reduce pain effectively,and it is safe. Furthermore,it has no influence on pulmonary function. Either, it has no influence on postoperative nausea or vomiting.