罗哌卡因和利多卡因在腹股沟疝修补术区域阻滞麻醉中的比较

目的 比较分别用罗哌卡因、利多卡因区域阻滞麻醉腹股沟疝手术的术中麻醉和术后镇痛效果.方法 采用随机、双盲、对照试验设计,选择ASA Ⅰ-Ⅲ级单侧腹股沟疝手术患者100例,随机分为罗哌卡因组和利多卡因组,每组50例,分别用0.75%罗哌卡因30 mL或1%利多卡因40 mL进行区域阻滞麻醉,采用巴德公司4700平片做李金斯坦术式腹股沟疝修补术.记录术后24 h内从注射研究药物至首次服用镇痛药的间隔时间和补充镇痛药总量.术中、术后伤口疼痛程度,以及日常活动问卷评分.结果 罗哌卡因组和利多卡因组服用镇痛药的时间间隔分别为22.35 h和15.05 h,组间差异无统计学意义(X2=0.191,P>0.05),但罗哌卡因组较对照组长7.3 h,用Cox回归模型分析,HR=0.888,(95%CL:0.521～1.514),即罗哌卡因组至首次服用补充镇痛药的间隔时间较利多卡因组延长11.2%.手术后第2小时静息时伤口疼痛评分、日常活动能力问卷总分和第4小时移动时疼痛单项评分,罗哌卡因组均低于利多卡因组,两组之间统计检验均有显著性差异(P<0.05).两组均未观察到不良事件.结论 0.75%罗哌卡因区域阻滞麻醉下行腹股沟疝修补术术中麻醉及术后镇痛效果好,镇痛时间长,安全性好,是腹股沟疝手术区域阻滞麻醉的理想药物.     

罗哌卡因和利多卡因在腹股沟疝修补术区域阻滞麻醉中的比较

目的 比较分别用罗哌卡因、利多卡因区域阻滞麻醉腹股沟疝手术的术中麻醉和术后镇痛效果.方法 采用随机、双盲、对照试验设计,选择ASA Ⅰ-Ⅲ级单侧腹股沟疝手术患者100例,随机分为罗哌卡因组和利多卡因组,每组50例,分别用0.75%罗哌卡因30 mL或1%利多卡因40 mL进行区域阻滞麻醉,采用巴德公司4700平片做李金斯坦术式腹股沟疝修补术.记录术后24 h内从注射研究药物至首次服用镇痛药的间隔时间和补充镇痛药总量.术中、术后伤口疼痛程度,以及日常活动问卷评分.结果 罗哌卡因组和利多卡因组服用镇痛药的时间间隔分别为22.35 h和15.05 h,组间差异无统计学意义(X2=0.191,P>0.05),但罗哌卡因组较对照组长7.3 h,用Cox回归模型分析,HR=0.888,(95%CL:0.521～1.514),即罗哌卡因组至首次服用补充镇痛药的间隔时间较利多卡因组延长11.2%.手术后第2小时静息时伤口疼痛评分、日常活动能力问卷总分和第4小时移动时疼痛单项评分,罗哌卡因组均低于利多卡因组,两组之间统计检验均有显著性差异(P<0.05).两组均未观察到不良事件.结论 0.75%罗哌卡因区域阻滞麻醉下行腹股沟疝修补术术中麻醉及术后镇痛效果好,镇痛时间长,安全性好,是腹股沟疝手术区域阻滞麻醉的理想药物.     

不同浓度罗哌卡因在腹股沟疝修补术中麻醉及镇痛效果对比

目的探讨不同浓度罗哌卡因在开放无张力腹股沟疝修补术中的应用及术后镇痛效果的差异。 方法选择2020年1月至2022年6月,濉溪县医院行开放式无张力腹股沟疝手术的患者78例为研究对象行前瞻性研究。以随机数字表法分成对照组和观察组,各39例。2组患者均采用超声引导下髂腹股沟神经阻滞联合腹直肌鞘阻滞。对照组应用0.2%罗哌卡因,观察组应用0.3%罗哌卡因。观察2组不同时点血流动力学指标、疼痛视觉模拟评分（VAS）、麻醉不良反应发生率、血清应激反应指标（肾上腺素、去甲肾上腺素、皮质醇）变化。 结果2组患者在手术前,切皮时,术后2 h的平均动脉压、心率、血氧饱和度差异无统计学意义（P>0.05）。观察组术后2 h、6 h、12 h VAS评分均低于对照组（P<0.05）。2组术后均未出现麻醉不良反应。血清应激反应指标2组术前0.5 h差异无统计学意义（P>0.05）,观察组术后2 h、8 h均低于对照组（P<0.05）。 结论开放性腹股沟疝修补手术,采用超声引导下髂腹股沟神经阻滞及腹直肌鞘阻滞的方法,应用不同浓度的罗哌卡因均可以较好地维持手术中的麻醉效果,但是0.3%罗哌卡因更利于患者术后早期镇痛,降低人体应激反应程度,且没有增加药物不良反应风险。     

利多卡因复合罗哌卡因在坐骨神经阻滞时的麻醉效果

腰丛复合坐骨神经阻滞作为临床麻醉在国内外报道逐渐增多，具有许多优点，尤其对全身各系统影响轻微，而且术后有较长的镇痛时间。但坐骨神经起效时间较长是其缺点，在很大程度上阻碍了此种麻醉方式在临床上的推广应用。笔者的前期研究得出坐骨神经应用2％利多卡因联合0．75％罗哌卡因10ml时，可以加快起效时间。本研究采用2％利多卡因10ml（约1．5倍ED50）复合0．75％罗哌卡因10ml应用于坐骨神经阻滞，验证这种复合用药的临床效果和起效时间，并与传统的硬膜外阻滞比较。     

盐酸罗哌卡因联合盐酸利多卡因在指屈肌腱鞘内阻滞麻醉中的疗效观察

目的探讨盐酸罗哌卡因联合盐酸利多卡因在指屈肌腱鞘内阻滞麻醉中的临床疗效。方法选择行指体中末节手术的成人患者60例,随机分为3组,每组20例。A,B,c组分别采用2％盐酸利多卡因、0．5％盐酸罗哌卡因联合1％盐酸利多卡因、1％盐酸罗哌卡因各4ml,行指屈肌腱鞘内阻滞麻醉。结果本组60例术后均获48h随访。麻醉起效时间A,B组短于C组（P〈0．05）,镇痛效果三组比较差异无显著性（P〉0．05）,镇痛持续时间B,C组长于A组（P〈O．05）,与镇痛药的协同作用B,C组强于A组（P〈0．05）,不良反应三组比较差异无显著性。结论盐酸罗哌卡因联合盐酸利多卡因在指屈肌腱鞘内阻滞麻醉中,不失为一种更佳的选择。     

罗哌卡因联合利多卡因在无张力腹股沟疝修补术中的疗效分析

目的探讨罗哌卡因联合利多卡因局部麻醉在腹股沟无张力疝修补术中的优势及可行性。方法回顾性分析2011年8月至2013年8月,遵义医学院成都附属医院收治的腹股沟疝患者210例,随机分为接受罗哌卡因联合利多卡因局部麻醉（试验组）和利多卡因单纯局部麻醉（对照组）,均行腹股沟无张力疝修补术。比较二组患者手术时间、镇痛效果及术后并发症等情况。结果试验组手术时间平均（43±12）min,明显短于对照组（56±11）min,二组比较差异有统计学意义（t=3．762,P=0．001）。试验组术后镇痛效果持续时间平均（10．4±1．6）h,长于对照组（4．2±1．3）h二组患者比较差异有统计学意义（t=6．843,P=0．ooo）,术后24d试验组无一例患者使用止痛药物,对照组有11例因疼痛使用止痛药物镇痛;术后3d试验组患者疼痛消失98例,对照组疼痛消失78例;术后7d,试验组有6例患者稍感局部疼痛,对照组有15例感局部疼痛,二组比较差异均有统计学意义（X2=12．290、7．870、4．881,P=0．000、0．005、0．027）。结论罗哌卡因与利多卡因混合局部麻醉下行腹股沟无张力疝修补术麻醉效果满意,操作简单,创伤小,安全性高,术后患者疼痛轻,恢复快,并发症少,患者满意度高,值得推广。     

甲磺酸罗哌卡因与盐酸罗哌卡因在硬膜外麻醉中的比较

盐酸罗哌卡因为长效酰胺类局麻药，广泛应用于硬膜外麻醉和术后镇痛，效果确切，中枢神经系统及心脏毒性较小。甲磺酸罗哌卡因是一种国产新型长效酰胺类局麻药，在化学结构上将盐酸罗哌卡因的盐酸根改为甲磺酸根。本研究比较手术患者甲磺酸罗哌卡因与盐酸罗哌卡因硬膜外麻醉的效果。     

0.25%罗哌卡因用于小儿骶管阻滞麻醉临床观察

目的评价0.25%罗哌卡因用于小儿骶管阻滞的安全性和有效性。方法15例1~8岁行下肢、会阴手术患儿,均在基础麻醉后行骶管阻滞,注入0.25%罗哌卡因0.8ml/kg。测定骶管阻滞的起效时间和镇痛时间,记录HR、MAP和SpO2及追加镇痛药量,并观察出现的不良反应。结果术中均无需追加镇痛药,麻醉效果满意。起效时间(75±20)min和镇痛时间(312±44)min,未观察到局麻药的毒性反应。结论0.25%罗哌卡因(0.8ml/kg)可提供满意的小儿骶管阻滞麻醉。     

罗哌卡因与丁哌卡因硬膜外麻醉剖宫产的药效学比较

目的 将新型酰胺类局部麻醉药罗哌卡因的的药效学与丁哌卡因进行比较。方法 选择行择期剖宫产的产妇２０例,分成两组进行硬膜外麻醉。随机在硬膜外注入０．７５％罗哌卡因。对镇平面及达到最高平面和最低平面所用时间,运动阻滞程度及恢复时间,术中镇痛效果,新生儿Ａｐｇａｒ评分,不良反应的发生情况,血压和心率的变化进行观察。．     

甲磺酸罗哌卡因与盐酸罗哌卡因用于硬膜外麻醉的临床观察

目的 评价甲磺酸罗哌卡因和盐酸罗哌卡因在下腹部和下肢手术患者中硬膜外麻醉的临床疗效及安全性.方法 选择下腹部或下肢手术受试者142例,随机均分为甲磺酸罗哌卡因组(A组)和盐酸罗哌卡因组(B组).取L1～2或L2～3穿刺点行硬膜外穿刺,向头端置管3 cm,注入首次剂量罗哌卡因15 ml.观察两组感觉阻滞起效时间、持续时间、感觉阻滞范围及运动阻滞Bromage评分及运动阻滞起效、持续时间;连续监测生命体征变化情况;观察术前及术后24 h内肝功能、肾功能等指标变化和低血压、心动过缓等不良反应.结果 两组感觉阻滞及运动阻滞各项观察指标差异均无统计学意义;受试者术中各项生命体征基本平稳;A组不良反应发生率为16.91%,明显低于B组的33.80%(P<0.05);两组均未发生严重不良事件.结论 甲磺酸罗哌卡因用于下腹部和下肢手术硬膜外麻醉安全有效,与盐酸罗哌卡因相当.     

Comparison of ropivacaine with bupivacaine and lidocaine for ilioinguinal block after ambulatory inguinal hernia repair in children

BACKGROUND: We have compared ropivacaine with bupivacaine and lidocaine for ilioinguinal block in thirty children undergoing ambulatory inguinal hernia repair. METHODS: Patients were assigned randomly to receive 0.5 ml.kg(-1) of 0.2% ropivacaine (Group R, n = 10), 0.25% bupivacaine (Group B, n = 10) or 1% lidocaine (Group L, n = 10). The patients' parents, who were not informed of the type of local anaesthetic employed, evaluated the postoperative pain at 2 h and 6 h after operation using the Wong-Baker FACES Pain Rating Scale. RESULTS: There was a significant difference in the face scale score between Group R and Group L, and Group B and Group L. There was no difference in the face scale score between Group R and Group B. There were no complications or clinical evidence of local anaesthetic toxicity. CONCLUSIONS: We have confirmed that bupivacaine and ropivacaine are more effective than lidocaine in the prevention of postoperative pain after children's inguinal hernia repair. We suggest that ropivacaine 0.2% is an alternative to bupivacaine 0.25% for ilioinguinal block in ambulatory paediatric surgery.     

Postoperative pain relief and recovery with ropivacaine infiltration after inguinal hernia repair

The purpose of this study was to assess the analgesic effects of wound infiltration with 300 mg ropivacaine. A total of 77 inpatients scheduled for inguinal hernia repair were randomized, to receive postoperative local infiltration with 40 ml ropivacaine 7.5 mg/ml or placebo. Wound pain, consumption of analgesics and time when patients were fit for discharge were assessed. Pain scores upon mobilization and coughing were significantly lower in the ropivacaine group over 0–24 h. At rest, this difference was noted until 12 h. The mean time to the first request for analgesics was significantly longer in the ropivacaine group. The consumption of analgesics was comparable. The median time when patients were fit for discharge occurred significantly earlier in the ropivacaine group. Wound infiltration with ropivacaine after inguinal hernia repair results in lower postoperative pain scores, delays the requirement for additional analgesics, and allows earlier patient discharge.     

罗哌卡因和利多卡因在腹股沟疝手术中的效果对比

目的探讨罗哌卡因和利多卡因在腹股沟疝手术中局部麻醉的效果差异。方法选择2018年1月至2019年11月在马鞍山中心医院接受腹股沟疝无张力修补手术治疗的患者90例。30例使用利多卡因局部麻醉的患者作为A组,30例使用利多卡因联合0.375%罗哌卡因的患者作为B组,30例使用利多卡因联合0.75%罗哌卡因的患者作为C组。对比3组的血流动力学指标[平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO₂)]、手术情况相关指标(手术耗时、失血量、住院时间)、麻醉效果相关指标[麻醉起效时间、麻醉持续时间、术后患者的视觉模拟评分(VAS)]、术后不良反应。结果3组患者在麻醉前、麻醉后1、5、10 min的MAP、HR、SpO₂数据差异无统计学意义(P>0.05)。3组患者的手术耗时、失血量数据差异无统计学意义(P>0.05)。B组和C组的住院时间短于A组(P<0.05)。B组和C组的麻醉起效时间长于A组(P<0.05)。C组的麻醉持续时间长于B组,B组的麻醉持续时间长于A组(P<0.05)。C组在术后1、3、6、9 h的VAS评分低于B组,B组在术后1、3、6、9 h的VAS评分低于A组(P<0.05)。3组在术后12、24 h的VAS评分差异无统计学意义(P>0.05)。3组的术后不良反应差异无统计学意义(P>0.05)。结论对于接受腹股沟疝无张力修补手术的患者,采用含有利多卡因或者罗哌卡因的局部麻醉方法均可以保证手术过程中的血流动力学稳定以及麻醉效果。利多卡因的起效时间更快,罗哌卡因的镇痛效果维持时间更长,使用浓度为0.75%罗哌卡因与利多卡因联合使用,患者可获得更好的术后镇痛效果,且用药的安全性良好。     

Pain relief by wound infiltration with bupivacaine or high-dose ropivacaine after inguinal hernia repair

BACKGROUND AND OBJECTIVES: Wound infiltration with bupivacaine is often used for pain relief after inguinal hernia surgery. We hypothesized that the lower systemic toxicity of another long-acting local anesthetic of similar potency (ropivacaine) would make it possible to increase the dose to above that recommended for bupivacaine and thereby achieve more effective pain control. METHODS: Elective unilateral open hernia repair was performed on 144 patients at 4 hospitals. Surgery was performed under general anesthesia and, in a double-blind manner, the operating field was infiltrated with 40 mL ropivacaine 7.5 mg/mL (in = 73) or bupivacaine 2.5 mg/mL (n = 71 ) for postoperative pain relief. Pain at rest, on mobilization, and on coughing was assessed repeatedly during 24 hours using a visual analog scale. The patients' ability to walk and the need for supplementary analgesics were also recorded. RESULTS: No statistically significant differences were found between the two groups with respect to pain scores, which the patients reported to be less than 15% (median) of the worst pain imaginable in all examinations performed at rest, or in the consumption of supplementary analgesics. Those who received ropivacaine could walk with no or only minor problems at an earlier stage than the bupivacaine patients (P < .03). Both treatments were well tolerated. CONCLUSIONS: Wound infiltration with long-acting local anesthetics resulted in low pain scores after hernia surgery. Bupivacaine 100 mg was as effective as ropivacaine 300 mg.     

腹腔镜完全腹膜外腹股沟疝修补术与Lichtenstein修补术的比较

目的对比腹腔镜完全腹膜外腹股沟疝修补术与Lichtenstein修补术的临床疗效。方法选择2008年4月至2009年5月245例腹股沟疝患者,随机分成两组,TEP组行腹腔镜全腹膜外腹股沟疝修补术,Lichtenstein组行Lichtenstein修补术。对比两组患者手术时间、平均住院时间、住院费用、平均恢复正常活动时间以及近远期并发症等指标,评价两种手术方式的疗效。结果 TEP组行单侧疝修补术的手术时间长,平均住院费用高,术中中转手术方式比例高,但恢复正常活动时间短,术后近远期并发症少。结论尽管TEP术存在手术时间长、住院费用高、术中中转手术概率高等缺点,但术后疼痛少,恢复正常活动时间短,对于有经验的外科医生应作为首选术式。     

Laparoscopic repair of inguinal hernia in infants: Comparison with open hernia repair

Purpose

This study aimed to evaluate the usefulness of laparoscopic repair of inguinal hernia (LR) in infants in comparison with open hernia repair (OR).

Comparison of modified darn repair and Lichtenstein repair of primary inguinal hernias

OBJECTIVE: This study was designed to compare the results of the Modified Darn Repair through Lichtenstein procedure in inguinal hernias. MATERIALS AND METHODS: The study involved 322 patients with inguinal hernia, operated in General Surgery Departments of Gulhane Military Medical Academy and Sirnak Military Hospital between 1998 and 2004. The durations of operation time, hospitalization, and time to return to daily activities and postoperative complication and recurrence rates were evaluated. Lichtenstein procedure was applied on 170 patients (Group 1), and modified darn repair was applied on 152 patients (Group 2). RESULTS: The average follow-up period was 56 months. For the Lichtenstein procedure, the average duration of operation was 56 min; the average time to return to routine activities was 20 days. The number of patients with postoperative complications was 20 (11.7%), and the number of patients with recurrence was 1 (0.6%). For modified darn repair, the average duration of operation was 48 min; the time to return to daily activities was 20 days. The number of patients with postoperative complication was three (1.9%), and no recurrences were noted. The hospitalization time of the groups was similar. DISCUSSION: Modified darn repair is a reliable method for inguinal hernia repair with short hospitalization time, low rate of postoperative complications, and recurrence.     

Comparison of Shouldice and Lichtenstein repair for treatment of primary inguinal hernia

Purpose: The purpose of this study was to compare the outcome following Lichtenstein open mesh repair or Shouldice repair for the surgical treatment of primary unilateral inguinal hernias.

Patients and methods: Patients with primary unilateral inguinal hernia who underwent a Shouldice repair (n: 120) and a Lichtenstein open mesh techniques (n: 121) between 1994 and 1998 were evaluated retrospectively. Operation time, hospital stay, postoperative analgesic consumption and complications, return to work and recurrence after surgery were assessed and compared.

Results: The two groups were comparable regarding age, types of hernia and the follow-up interval. There were no significant differences in hospital stay and postoperative complications. The number of recurrences differed significantly between the groups with five in the Shouldice group (4.1%) and one in the Lichtenstein group (0.8%) (p < 0.05). The need of analgesic medication after mesh repair was significantly lower than the Shouldice group (3.9 ±1.4 vs. 4.9 ±1.6 gr. p < 0.05). The operation time was 36±14 min. for Lichtenstein repair and 61 ± 12 min. for Shouldice repair (p < 0.05). The time for return to work was shorter in Lichtenstein group (17 ± 4 days) compared to Shouldice group (25 ±5 days) (p< 0.05).

Conclusion: Shorter operation time, faster return to work, less need to analgesia and lower recurrence rate, shows the superiority of Lichtenstein repair against Shouldice repair in the surgical repair of primary unilateral inguinal hernia.