The search for cost-effective prevention of postoperative nausea and vomiting in the child undergoing reconstructive burn surgery: ondansetron versus dimenhydrinate.

Postoperative nausea and vomiting (PONV) is a common and unpleasant problem for children with burns who are undergoing reconstructive burn surgery. Ondansetron and dimenhydrinate have been found to be effective for the prevention of PONV in other patient populations, but they have not been directly compared in the pediatric population. A prospective, randomized, double-blind, placebo-controlled comparison of ondansetron and dimenhydrinate was performed. One hundred patients with a mean age of 11.8 years who were undergoing reconstructive burn surgery with general anesthesia were randomly assigned to receive either a placebo, 0.1 mg/kg of ondansetron, or 0.5 mg/kg of dimenhydrinate. The 3 groups were well matched for all demographic and procedural variables. The study drugs were given twice, first at the end of surgery and again 4 hours later, to ensure adequate blood levels during the 8-hour study period. Postoperatively, on the basis of the presence and amount of PONV experienced, all patients were assigned a PONV score by a blinded investigator. Statistically significant reductions in the incidence of PONV in the patients who received ondansetron or dimenhydrinate were found, as compared with the results of patients who received placebo. Postoperative vomiting was reduced from 61% in the placebo group to 29% and 40% in the ondansetron and dimenhydrinate groups, respectively, and PONV was similarly reduced from 69% to 47% and 40%, respectively. The differences between ondansetron and dimenhydrinate were not significant. The average cost to our pharmacy for the prescribed dose of ondansetron was $19.34; the cost for dimenhydrinate was $0.90. In this patient population, dimenhydrinate was as effective as ondansetron for the prevention of PONV and postoperative vomiting, and it was much less expensive.     

托烷司琼复合氟哌啶醇与托烷司琼单用预防术后恶心呕吐的比较

目的:比较托烷司琼复合氟哌啶醇与单独使用托烷司琼预防术后恶心呕吐(PONV)的效果.方法:选择全身麻醉下行上腹部手术患者266例,随机分为托烷司琼组(T组)和托烷司琼复合氟哌啶醇组(T + H组).采用随机双盲法于手术结束前30 min给每位受试者静脉注射托烷司琼2 mg和试验用药1 mL(可能是1 mg氟哌啶醇或1 mL生理盐水),术后采用视觉模拟评分法(VAS)评估PONV程度.手术结束后记录恶心、干呕、呕吐和两组止吐药物治疗的情况,同时记录有无烦躁、谵妄、肌张力障碍、不能静坐和锥体外系反应.结果:术后恶心发生率T组37.6%,T + H组12.0%,T + H组明显低于T组(P ＜ 0.05);术后呕吐或干呕的发生率T组11.3%,T + H组4.5%,T + H组明显低于T组(P ＜ 0.05).T + H组预防PONV的疗效明显高于T组(P ＜ 0.05),只有少数恶心患者需给予止吐药物治疗.两组手术前后Q-T间期差异无统计学意义,两组中均未出现烦躁、谵妄、肌张力障碍、不能静坐和锥体外系反应患者.结论:托烷司琼复合氟哌啶醇对于预防PONV的效果和时程明显优于单独使用托烷司琼,且不增加不良反应的发生率.     

Transcutaneous electrical acupoint stimulation versus ondansetron in the prevention of postoperative vomiting following pediatric tonsillectomy

OBJECTIVES: Postoperative retching and vomiting is an important cause of morbidity that may lead to patient discomfort, distress, and complications. Stimulation of acupuncture points has been shown to be effective in the prevention as well as treatment of PONV. The current treatments of choice are the 5-hydroxytryptamine type 3-antagonists, such as ondansetron. We aimed to evaluate the efficacy and side-effects of either transcutaneous electrical acupoint stimulation (TEAS) or Ondansetron compared to a control group receiving no treatment in the prevention of postoperative retching and vomiting. SUBJECT AND DESIGN: This randomized, controlled, prospective study was carried out in a group of 90 children (in three equal randomly assigned groups), aged between 4 and 12 who underwent tonsillectomy under general anesthesia. In the first group, electrical stimulation via surface electrodes on acupoints Neiguan and Shangwan was performed (20 Hz, 5 minutes). The second group received a single dose of Ondansetron (0.15 mg . kg(-1)). No treatment was given to the control group. OUTCOME MEASURES: The frequency of retching and vomiting attacks and side-effects were noted on the day of surgery in the postanesthesia care unit and the day surgery care unit, on the day of surgery after discharge, and on the first day after surgery. A satisfaction scale was completed by each family. RESULTS: There was a significant difference between the treatment groups and the control group in the incidence of emetic episodes occurring in the day surgery care unit and on the day after discharge (p < 0.001). In the ondansetron group, side-effects were seen in more patients than in the other groups (p < 0.001). The satisfaction scores of the parents were greater in the treatment groups than in the control group (p < 0.05). CONCLUSION: Application of TEAS on sedated children is an easy, painless, reliable and effective method for the prophylaxis of postoperative retching and vomiting in pediatric tonsillectomy.     

Biphasic dosing regimen of meclizine for prevention of postoperative nausea and vomiting in a high-risk population

The purpose of this study was to determine if giving 50 mg of meclizine the night before and on the day of surgery would effectively reduce postoperative nausea and vomiting (PONV) for the entire 24 hours after surgery in patients identified as being at high risk for PONV Subjects were randomly assigned to receive either 50 mg of oral meclizine (experimental group) or a placebo (control group) the night before and the day of surgery. All subjects were intravenously administered 4 mg of ondansetron before the conclusion of surgery. Seventy subjects (35 control; 35 experimental) were included in analysis. postoperaIn the placebo group we noted higher verbal numeric rating scale scores for nausea, a higher incidence oftive nausea and vomiting (PONV) continues to be a common complication after general anesthesia, with the incidence ranging from 17% to 87%.15 It has been reported that PONV increased antiemetic requirements, and lower overall anesthesia satisfaction scores at all time intervals measured, compared with the experimental group, but the differences were not statistically significant until analyzed by postoperative setting. No difference in sedation or side effects was noted between groups. Based on these results, we recommend that the administration of 50 mg of oral meclizine the night before and on the day of surgery be considered effective antiemetic prophylaxis in patients identified as having a high risk for PONV.     

地塞米松对术后硬膜外吗啡引起恶心呕吐的预防作用

目的:评价地塞米松对硬膜外吗啡引起恶心呕吐的预防效果。方法:妇科肿瘤择期手术病人120例,随机双盲分为地塞米松(A)组、恩丹西酮(B)组、生理盐水(C)组三组,每组40人。当手术开始时,随机给予地塞米松10 mg或者恩丹西酮8 mg或者生理盐水2 mL。所有病人在手术结束前1 h均接受硬膜外吗啡2 mg,然后以0.125％布比卡因100 mL和吗啡0.12mg/kg维持硬膜外术后止痛48 h,评价镇痛效果、恶心呕吐。结果:A组和B组早期和晚期恶心呕吐发生率低于C组(P<0.05),而A组和B组无差别(P>0.05)。结论:地塞米松和恩丹西酮均能降低硬膜外吗啡引起的恶心呕吐,地塞米松对术后硬膜外吗啡引起的恶心呕吐有预防作用。     

右美托咪定对小儿七氟烷吸入麻醉苏醒期躁动的影响

目的探讨右美托咪定对小儿七氟烷吸入麻醉苏醒期躁动的影响。方法选择2011年3月-2012年1月美国麻醉医师协会分级Ⅰ～Ⅱ级、年龄2～8岁、择期行疝囊高位结扎术和隐睾下降固定术患儿40例,随机分为2组,右美托咪定组(A组)和对照组(B组),两组患儿在年龄、体重、手术种类无明显差异。两组患儿均采用面罩8%七氟烷吸入麻醉诱导,开放静脉,给予盐酸戊乙奎醚0.1 mg/kg、顺式阿曲库铵0.15 mg/kg,插入喉罩,麻醉维持根据血压、心率及脑电双频指数调节吸入麻醉药浓度。A组静脉给予1μg/kg右美托咪定,B组给予同等容量的生理盐水。入室至手术结束时连续观察收缩压、舒张压、心率、血氧饱和度,记录清醒时间、拔除喉罩时间,记录苏醒期并发症的发生数。记录入麻醉恢复室即刻(0 min)、15、30、60、90 min患儿疼痛和躁动评分。结果两组患儿在手术时间、清醒时间以及拔除喉罩时间差异无统计学意义(P>0.05),A组术后入恢复室0、15、30 min疼痛评分和躁动评分均低于B组(P<0.05),两组患儿围术期均未出现低血压和心动过缓。结论右美托咪定用于小儿七氟烷吸入麻醉能够增强术后镇痛,减少苏醒期躁动。     

A randomized, double-blind trial of palonosetron compared with ondansetron in preventing postoperative nausea and vomiting after gynaecological laparoscopic surgery

This randomized, double-blind study evaluated the relative efficacy of palonosetron (a new, selective 5-hydroxytryptamine type 3 [5-HT(3)] receptor antagonist) and ondansetron in preventing postoperative nausea and vomiting (PONV) in patients undergoing gynaecological laparoscopic surgery. Patients received either palonosetron 0.075 mg (n = 45) or ondansetron 8 mg (n = 45), intravenously, immediately before induction of general anaesthesia. The occurrence of nausea and vomiting and the severity of nausea according to a visual analogue scale were monitored immediately after the end of surgery and during the following 24 h. The incidence of PONV was significantly lower in the palonosetron group compared with the ondansetron group (42.2% vs 66.7%, respectively). There were no significant statistical differences in the visual analogue scale for nausea. In conclusion, palonosetron 0.075 mg was more effective than ondansetron 8 mg in preventing PONV.     

地佐辛配伍丙泊酚联合喉罩用于纤维支气管镜检查的临床研究

目的 评价地佐辛配伍丙泊酚联合喉罩用于无痛纤维支气管镜检查的效果。 方法 将2012年10月－12月拟行纤维支气管镜检查,且按美国麻醉医师协会分级Ⅰ或Ⅱ级的60例患者,随机分为芬太尼组（F组）、地佐辛组（D组）、生理盐水组（N组）,每组20例。采用双盲法给药,静脉注射芬太尼（10 μg/mL）或地佐辛（1 mg/mL）或生理盐水0.1 mL/kg,5 min后3组缓慢静脉注射丙泊酚2 mg/kg诱导后置入喉罩,术中保留自主呼吸,持续泵入丙泊酚4～6 mg/（kg·h）维持麻醉,观察3组患者诱导前（T0）、诱导后时（T1）、纤维支气管镜操作时（T2）、术毕时（T3）及拔除喉罩时（T4）的生命体征,记录丙泊酚总用量、苏醒时间、苏醒时的呼吸道疼痛视觉模拟评分（VAS）,记录术中及术后有关并发症的发生情况。 结果 与N组相比,D、F两组丙泊酚总用量减少、苏醒时间缩短,头昏及术中体动发生率、VAS评分明显降低（P＜0.05）;呼吸暂停的发生率D组最低（P＜0.05）;恶心、呕吐的发生率F组最高（P＜0.05）。 结论 地佐辛配伍丙泊酚联合喉罩用于无痛纤维支气管镜检查,麻醉效果满意,术后镇痛效果好,值得临床推广。     

利多卡因静脉注射对芬太尼诱导小儿咳嗽的影响

目的：观察利多卡因静脉注射对芬太尼诱导小儿咳嗽的影响。方法择期手术患儿93例,拟于全身麻醉下进行,年龄4~10岁,体质量10~35 kg,性别不限,ASA 分级Ⅰ级或Ⅱ级,采用随机数字表法将其分为3组：对照组（C 组）31例、利多卡因0.5 mg/ kg 组（L1组）31例、利多卡因1.0 mg/ kg 组（L2组）31例。L1和 L2组于麻醉诱导静脉注射芬太尼2~3μg/ kg 前经超过65 s 分别静脉注射利多卡因0.5 mg/ kg 和1.0 mg/ kg,C 组给予同等剂量生理盐水。记录患儿麻醉诱导期咳嗽的发生情况及严重程度。结果与 C 组比较,L1组与 L2组患儿咳嗽的发生率与咳嗽的严重程度降低（P 〈0.05 或 〈0.01）;L1、L2组间比较,上述指标差异无统计学意义（P 〉0.05）。结论利多卡因静脉注射可抑制芬太尼诱导的小儿咳嗽。     

Procedures for preventing postoperative nausea and vomiting after laparoscopic cholecystectomy: dexamethasone and ondansetron

This randomized double-blind study was undertaken to evaluate the efficacy of ondasetron and dexamathesone in reducing the incidence of postoperative nausea and vomiting after laparoscopic cholecystectomy. The study covered 60 patients (ASA I/II) who had undergone laparoscopic cholecystectomy under general anesthesia. The patients were divided into two groups: 1) 30 patients who received dexamethasone, 4 mg i.v.; and 2) 30 patients who took ondansetron, 4 mg i.v., prior to general anesthesia. Postoperatively, nausea, vomiting, and severe pain (VAS) were observed every 6 hours within the first 24 hours. Postoperative nausea and vomiting occurred in 6 (20) patients in Group I and in 13 (43.33) patients in Group 2 (p < 0.05), while vomiting did only in 5 (16.66%) patients in Group I and 4 (13.33%) in Group 2 (p > 0.05). The least intensity of postoperative pain was observed in Group 1, but the difference between the study groups was insignificant. It is concluded that dexamethasone is more effective in preventing postoperative nausea and vomiting after laparoscopic cholecystectomy than ondansetron. This is mainly determined by a significant reduction in the incidence of postoperative nausea.     

格拉司琼预防小儿腹腔镜手术后恶心呕吐

目的观察格拉司琼预防全麻下小儿腹腔镜手术后恶心呕吐的临床效果。方法选择80例ASAⅠ～Ⅱ级行择期全麻下腹腔镜手术的患儿,年龄2～10岁,随机分为两组,每组40例。对照组(C组)给予生理盐水5 ml;格拉司琼组(G组)给予格拉司琼40μg/kg,两组均于手术结束时静脉注射,观察24 h内患儿发生恶心呕吐的次数,计算呕吐率。结果术后恶心呕吐发生率对照组(C组)明显高于格拉司琼组(G组),差异有统计学意义(P0.01)。结论格拉司琼能有效减少小儿腹腔镜手术后的恶心呕吐。     

Ciprofloxacin concentrations and impact of the colon microflora in patients undergoing colorectal surgery.

Ciprofloxacin was given perorally in two doses of 750 mg each with a 12-h interval starting 24 h prior to surgery, 400 mg of ciprofloxacin was given intravenously at the induction of anesthesia, and 400 mg of ciprofloxacin was given 12 h later to 21 patients undergoing elective colorectal surgery. The maximum concentrations in serum (mean value +/- standard deviation, 11.1 +/- 7.8 mg/liter) during surgery were reached 30 min after ciprofloxacin was administered. The ciprofloxacin concentrations in the intestinal mucosa samples were 2.7 to 37.8 mg/kg of tissue weight, and the concentrations in the fecal samples were less than 0.1 to 858 mg/kg. The aerobic and anaerobic bacteria in the fecal flora were suppressed markedly during the prophylaxis period. No postoperative infections occurred.     

Results of a prospective, randomized, double-blind, placebo-controlled, dose-ranging trial to determine the effective dose of ramosetron for the prevention of vomiting after tonsillectomy in children

BACKGROUND: Postoperative vomiting (POV) is an important adverse effect of anesthesia and surgery, and children undergoing tonsillectomy may be particularly at risk. OBJECTIVE: The aim of this study was to determine the effective dose of ramosetron, a 5-hydroxytryptamine type 3 receptor antagonist, for prophylaxis of severe POV (> or =2 episodes) in children undergoing general anesthesia for tonsillectomy. METHODS: Standard general anesthetic technique and postoperative analgesia were used in this prospective, randomized, double-blind, placebo-controlled, dose-ranging trial of pediatric patients. Patients who had experienced POV, had taken an antiemetic medication within 24 hours before surgery of had a history of motion sickness were excluded. Only patients aged 4 to 10 years were included, because of their ability to answer questions. Patients received a single administration of either i.v. placebo or i.v. ramosetron at 3, 6, or 12 microg/kg immediately after the end of surgery. During the first 48 hours after anesthesia, episodes of retching, vomiting, and adverse events were recorded by nursing staff blinded to treatment assignment. RESULTS: Eighty children (20 in each group)--42 girls and 38 boys--were enrolled. There were no differences in patient demographic characteristics among the treatment groups. The rates of complete response (no vomiting, retching, or need for another antiemetic medication) from 0 to 24 hours after anesthesia were 35% (7/20) with ramosetron 3 microg/kg, 90% (18/20) with ramosetron 6 micro/kg, and 90% (18/20) with ramosetron 12 microg/kg compared with placebo (30% [620], P=NS, P=0.001, and P=0.001 vs placebo, respectively); the corresponding rates from 24 to 48 hours after anesthesia were 35% (7/20), 90% (18/20), and 95% (19/20) compared with placebo (35% [7/20]; P=NS, P=0.001, and P=0.001 vs placebo, respectively). No difference in antiemetic efficacy was observed between ramosetron 6 and 12 microg/kg. No clinically serious adverse events attributable to the study drug were observed in any group. CONCLUSIONS: In the pediatric population studied, ramosetron 6 microg/kg was effective for the prevention of vomiting after tonsillectomy from 0 to 48 hours after anesthesia. Increasing the dose to 12 microg/kg did not appear to provide further benefit.     

氟哌利多和曲马多预注在乳腺手术的超前镇痛效果观察

目的探讨氟哌利多和曲马多预防乳腺包块切除术后急性疼痛的效果。方法 60例ASAⅠ～Ⅱ级择期行乳腺包块切除术患者,分为A、B两组各30例。A组麻醉诱导后喉罩置入前静脉注射氟哌利多1 mg、曲马多3 mg/kg;B组手术结束前10～20min静脉注射氟哌利多1 mg、曲马多3 mg/kg。两组患者诱导用顺时阿曲库铵0.1 mg/kg、咪唑安定0.03 mg/kg、丙泊酚1～1.5 mg/kg、雷米芬太尼1μg/kg、地塞米松10 mg。意识消失后置入4#喉罩。麻醉维持以雷米芬太尼0.1～0.25μg/（kg.min）、丙泊酚5～8 mg/（kg.h）微量泵持续输注。在缝皮结束前2 min停麻醉药。记录患者完全清醒时和清醒后0.5、1、2、4、6、8 h的疼痛视觉模拟评分（VAS）评分及不良反应。结果术后0.5、1、2、4、6 h VAS评分A组明显低于B组（P〈0.05）,而8 h两组差异无统计学意义（P〉0.05）;不良反应的发生率A组低于B组（P〈0.05）。结论 应用氟哌利多和曲马多预防乳腺包块切除术后急性疼痛,麻醉诱导后喉罩置入前用药效果优于手术结束前用药,提示氟哌利多和曲马多具有超前镇痛作用。     

DAT-582, a novel serotonin3 receptor antagonist, is a potent and long-lasting antiemetic agent in the ferret and dog.

The antiemetic effects of a novel serotonin3 receptor antagonist, DAT-582 [(6R)-(-)-N-[1-methyl-4-(3-methylbenzyl)hexahydro-1H-1,4- diazepin-6-yl]-1H-indazole-3-carboxamide dihydrochloride] were compared with those of the existing serotonin3 receptor antagonists, ondansetron and granisetron, in experimental animals. In ferrets, DAT-582 (0.003-0.1 mg/kg i.v. twice) dose-relatedly prolonged the latency to the first emetic episode and decreased the number of emetic episodes induced by cisplatin (10 mg/kg i.v.). DAT-582 was more potent than ondansetron or granisetron in inhibiting the emesis. The emesis induced by cyclophosphamide (150 mg/kg i.v.), doxorubicin (15 mg/kg i.v.) or combination of cisplatin (3.3 mg/kg i.v.), cyclophosphamide (50 mg/kg i.v.) and doxorubicin (5 mg/kg i.v.) was also inhibited by DAT-582 (0.1 mg/kg i.v., twice). When administered 2 hr before cisplatin in ferrets, DAT-582 decreased markedly the number of emetic episodes induced by cisplatin at 0.1 mg/kg i.v., whereas ondansetron and granisetron were without effect even at 0.3 mg/kg i.v. DAT-582 (0.1 mg/kg i.v.), when administered in the ferrets which were vomiting after cisplatin, immediately and almost completely blocked the subsequent emesis. Furthermore, DAT-582 (0.1 mg/kg i.v.) completely inhibited the cisplatin (3 mg/kg i.v.)-induced emesis for 24 hr after cisplatin in three of five dogs. In addition, DAT-582, at 0.3 and 1 mg/kg, p.o., inhibited the cisplatin-induced emesis in dogs. However, DAT-582, even at 3 mg/kg s.c., did not inhibit the apomorphine (0.3 mg/kg,, s.c.)-induced emesis in dogs, or the nicotine-, copper sulfate- or motion stimulus-induced emesis in the house musk shrew, Suncus Murinus.(ABSTRACT TRUNCATED AT 250 WORDS)     

异丙酚在小儿内眼手术麻醉中的应用

目的：比较氯胺酮和异丙酚分别用于小儿内眼手术麻醉的异同点。方法：选择80例小儿择期内眼手术患者.年龄81d～12岁，随机分为氯胺酮＋局麻组和异丙酚＋局麻组。每组40例，观察眼压、循环和术后恢复情况等指标。结果：异丙酚在降低眼压，保持循环系统相对稳定，缩短苏醒时间和减轻术后不良反应等方面均优于氯胺酮。     

七氟烷全麻下小儿斜视术后躁动的预防与护理

目的探讨七氟烷全麻下行斜视手术小儿恢复期躁动的预防措施及护理对策。方法择期小儿斜视手术46例,随机分为观察组（n=23）和对照组（n=23）。2组均采用七氟烷诱导,插入喉罩,术中七氟烷吸入维持。手术开始前观察组静脉注射氯诺昔康0．2mg／kg,对照组静脉注射等量生理盐水。观察2组镇静、镇痛效果。结果与对照组比较,观察组的镇痛效果提高（P〈0．05）;谵妄、躁动发生减少（P〈0．05）;镇静效果差异无统计学意义（P〉0．05）。结论静脉注射氯诺昔康具有良好的镇痛效果,并可预防小儿斜视七氟烷全麻恢复期谵妄躁动的发生,同时相应的护理措施可减少术后躁动的发生。     

Does intramuscular ondansetron have an effect on intramuscular ketamine-associated vomiting in children? A prospective,randomized, double blind,controlled study

ObjectiveThis study was conducted to determine the effect of intramuscular ondansetron on ketamine-associated vomiting in children undergoing procedural sedation.MethodsThis randomized, double-blind, placebo-controlled, parallel-group clinical trial was conducted at the emergency departments of two university-affiliated tertiary care hospitals. Eligible participants included all 6-month to 16-year-old children who received IM ketamine for PSA in the ED. A convenience sampling approach was used and a block randomization method was applied (blocks of four) using a computer-generated random sequence. Patients received ketamine 4 mg/kg or ketamine 4 mg/kg plus ondansetron 0.1 mg/kg intramuscularly. All findings including the occurrence of vomiting and its frequency were then recorded in the data collection sheets.ResultsOf 56 patients who received ondansetron plus ketamin, 7 (12.5%) and 1 (1.8%) experienced vomiting during recovery and before discharge and Of 65 patients in the control group, 14 (21.5%) and 6 (9.2%) experienced vomiting during recovery and before discharge, respectively. The observed differences in the rates of vomiting during recovery and at discharge were statistically significant between the two groups (P-value of 0.03 and <0.001, respectively).ConclusionIntramuscular ondansetron is effective in controlling ketamine-associated vomiting.     

Modern approaches to the management of an anesthesiological support in pediatric ENT surgery

The paper deals with the topical problem of pediatric anesthesiology--current approaches to performing an anesthesiological appliance in pediatric ENT surgery. The study included 1299 children aged 3 days of life to 14 with various surgical ENT abnormalities at anesthesia risk I-III (ASA) in whom surgical intervention was performed under multicomponent general anesthesia or under local anesthesia. The paper comparatively characterizes the currently available methods for general anesthesia used during both short ENT surgery and long endonasal microendoscopic interventions. The effectiveness and safety of different procedures for maintenance of free airway patency, such as endotracheal intubation, a laryngeal mask, a COPA-airline, were compared. Since adenoid- and/or tonsillectomy, as well as tonsillotomy are the most common operations in pediatric ENT surgery, indications for and contraindications to these interventions under general anesthesia were defined. It has been shown that endonasal microendoscopic operations in children should be performed exclusively under general endotracheal anesthesia and local anesthesia is a mere one of its important constituents.     

罗哌卡因术毕切口浸润在腹腔镜全麻术后镇痛中的应用

目的 观察腹腔镜全麻术毕切口浸润罗哌卡因对术后镇痛及减少不良反应的影响.方法选取18~75岁、ASA Ⅰ~Ⅱ级行腹腔镜胆囊手术患者60例,随机分为三组,罗哌卡因组(R组)患者在关气腹后以0.75%罗哌卡因(阿斯利康公司生产的0.75%耐乐品)逐次浸润每个切口2~3 ml;曲马多组(T组)关气腹后给予1 mg/kg曲马多;芬太尼组(F组)关气腹后给予1 μg/kg芬太尼.三组术前静脉加用昂丹司琼8 mg防止术后呕吐,以咪达唑仑0.05 mg/kg、维库溴铵0.1 mg/kg、依托咪酯0.3 mg/kg、芬太尼4 μg/kg诱导,术中以瑞芬太尼、异丙酚和维库溴铵维持麻醉深度,不再追加阿片类药物.术后采用镇痛泵[吗啡0.2 mg/(kg·d)+格拉司琼3 mg/d].记录三组患者拔管后即刻及术后 4、8、12、24、48 h VAS评分结果,以及患者术后首次加用阿片类止痛药的时间和不良反应.结果 R组在拔管后即刻及术后4、8、12、24 h VAS评分明显低于T组和F组(P<0.05).F组与T组在术后VAS评分上比较差异无统计学意义(P>0.05).术后首次加用止痛药物的时间三组比较差异无统计学意义,三组术后恶心、呕吐、口干等不良反应发生率比较差异均无统计学意义(P>0.05).结论 术毕切口浸润罗哌卡因可安全有效减轻全麻腹腔镜患者术后疼痛,且不增加相关不良反应.