布托啡诺用于腹腔镜胆囊切除术后镇痛效果评价

腹腔镜手术因其创伤小、术后恢复快,越来越多地应用于外科手术中,其术后切口疼痛虽不及剖腹手术严重,但是术后疼痛仍然存在,影响患者术后恢复[1].本研究以布托啡诺、曲马多以及芬太尼用于腹腔镜胆囊切除术后镇痛,探讨其效果和不良反应.     

预注不同剂量布托啡诺对妇科腹腔镜患者术后镇痛效果的比较

目的 比较不同剂量布托啡诺静脉预注用于腹腔镜子宫切除术( laparoscopically hysterectom,LH)对患者术后镇痛作用的影响.方法 48例行全麻下择期LH患者,年龄35岁～60岁,ASA Ⅰ ～Ⅱ级,采用随机数字表法随机分为4组(每组12例),B1组、B2组、B3组分别于切皮前10 min缓注布托...     

不同剂量布托啡诺超前镇痛应用于腹腔镜胆囊切除术的效果

中枢敏化可对疼痛产生不利影响,故有人主张在手术开始前就采取措施,以阻滞伤害性感受器,从而达到防止中枢敏化、减轻术后疼痛的目的[1].这种方法被称之为"超前镇痛".布托啡诺主要激动k受体,而作为μ受体激动-拮抗     

不同剂量布托啡诺用于乳房肿块切除术后的镇痛效果和不良反应

布托啡诺是一种新合成的阿片受体激动-拮抗药[1],主要通过作用于κ受体产生镇痛效应,对于μ、δ受体的作用甚微。乳房肿块切除术虽然是一短小手术,但术后仍有中度疼痛。本研究旨在观察布托啡诺用于乳房肿块切除术后的镇痛效果及不良反应,寻找布托啡诺用于乳房肿块切除术后镇痛的合适剂量。资料与方法一般资料选择择期行乳房肿块切除术的女性患者120例,ASAⅠ或Ⅱ级,年龄18~60岁,体重40~70kg,术前未使用地西泮、吗啡等镇静镇痛药,随机分为布托啡诺1、2、3组(B1、B2、B3组)和对照组(C组),每组30例。麻醉方法麻醉前30min肌注苯巴比妥钠0.1g、…     

硬膜外泵入布托啡诺复合小剂量氯胺酮用于妇科患者术后镇痛

目的 观察术后硬膜外持续泵人布托啡诺复合小剂量氯胺酮用于妇科患者术后的镇痛效果.方法 60例ASA Ⅰ或Ⅱ级在腰-硬联合麻醉下行腹式子宫切除的妇科患者术后随机均分为两组,A组为观察组,用布托啡诺0.1 mg/kg 氯胺酮1 mg/kg 生理盐水至100 ml持续泵人;B组为对照组,用布托啡诺0.1 mg/kg 生理盐水至100 ml持续泵入.观察患者术后各时间段的视觉模拟镇痛评分(VAS)、Ramsay镇静评分及对术后镇痛的满意度进行评估,并观察不良反应情况.结果 A组在给药后4 h的VAS低于B组(P<0.05);B组在给药后4、8和12 h的Ramsay镇静评分高于A组(P<0.05),但是两组的评分均在镇静满意的范围.结论 硬膜外持续泵入布托啡诺0.1mg/kg对于妇科术后患者能提供安全有效的镇痛,同时复合小剂量的氯胺酮能增强其镇痛效果,不增加其不良反应的发生.     

布托啡诺硬膜外术后镇痛对胃肠动力的影响

阿片受体激动拮抗药布托啡诺主要激动κ受体发挥镇痛作用,对μ受体有弱拮抗作用,用作硬膜外术后镇痛对胃肠道功能影响文献报道不多.本研究观察并比较布托啡诺与吗啡用作胆囊切除术后硬膜外镇痛对病人胃肠道功能恢复的影响,选择更有利于病人术后恢复的镇痛药配方.[第一段]     

酒石酸布托啡诺在隆乳术后镇痛中的应用

目的:观察酒石酸布托啡诺用于隆乳术后镇痛的效果。方法:选择术后短期留院观察,行硅胶假体隆乳手术的患者90例,ASA I～I I级。静脉复合气管插管麻醉手术后,随机将要求镇痛的患者分为芬太尼自控镇痛F组、酒石酸布托啡诺自控镇痛B组,开始自控静脉镇痛;拒绝实施术后镇痛的患者作为对照C组,观察患者术后24h内镇痛评分及不良反应的发生情况。结果:酒石酸布托啡诺自控镇痛B组与芬太尼自控镇痛F组镇痛效果显著。B组患者术后疼痛评分明显低于对照组;不良反应发生率依次为:B组相似文献   

布托啡诺静脉镇痛对断指再植成活的影响

断指再植手术术中要求麻醉平稳,术后镇痛完善.防止患指血管痉挛,减少再植后血管危象的发生,是确保再植指成活的重要因素.2003～2006年期间我院采用布托啡诺术后静脉自控镇痛(PCIA)对再植指成活率的观察,取得了良好效果.     

酒石酸布托啡诺在硬膜外术后镇痛中的应用

目的通过与吗啡作对比研究酒石酸布托啡诺在术后硬膜外镇痛中的效能和副作用。方法56例择期行在腰硬联合麻醉下行下腹部手术患者,男36例,女20例,年龄21岁～63岁,ASAⅠ～Ⅱ,随机分成二组：M组（吗啡组n=28）：0．004％吗啡＋0．12％布比卡因,B组（酒石酸布托啡诺n=28）：0．004％酒石酸布托啡诺＋0．12％布比卡因,进行硬膜外术后镇痛。手术缝皮时分别向两组病人硬膜外腔注射吗啡或酒石酸布托啡诺1mg做为负荷剂量,然后接硬膜外PCA泵,参数设定如下背景输入速度2ml／h,自控镇痛剂量0．5ml／次,锁定时间15min。用VAS评分评价镇痛效果,同时观察硬膜外术后镇痛的并发症。结果两组镇痛效果都较为满意;酒石酸布托啡诺组的VAS评分低于吗啡组,但无统计学意义。酒石酸布托啡诺组瘙痒、恶心、呕吐的发生率低于吗啡组。结论酒石酸布托啡诺硬膜外术后镇痛效果可靠,副作用少,值得在临床中推广使用。     

布托啡诺在术后镇痛的应用

目的观察布托啡诺用于术后镇痛的效果。方法105例硬膜外麻醉术后患者随机均分为芬太尼镇痛组（Ⅰ组）,曲马多镇痛组（Ⅱ组）和布托啡诺镇痛组（Ⅲ组）,比较术后镇痛效果和副作用。结果三组均获得了满意的术后镇痛效果。其中Ⅰ组术后4h VAS和术后24h D1／D2值分别小于Ⅱ组（P〈0．05）。头痛头晕Ⅱ组多于Ⅰ组（P〈0．05）。排尿困难Ⅲ组少于Ⅰ组（P〈0．05）。OAA／S评分Ⅲ组分别大于Ⅰ组和Ⅱ组（P〈0．05或P〈0．01）。结论布托啡诺在下腹部和下肢手术是一种有效术后镇痛药物,副作用较少,但嗜睡副作用应引起高度重视。     

The evolution of postoperative ileus after laparoscopic cholecystectomy

Summary Our study is prompted by the arrival of laparoscopic cholecystectomy in connection with the evolution of postoperative ileus (PI) and by its avoidance of the intraabdominal handling implied in conventional cholecystectomy.With this aim a prospective, controlled, randomized, and blind clinical trial was designed using 100 patients divided into five groups (n=20): I, conventional cholecystectomy (CC); II, CC + injection of 20 ml bupivacaine 0.5% into the mesentery root; III, CC + 7.5 mg propanolol i.v. and 0.5 mg neostigmine s.c., postoperatively until the first defecation; IV, II + III; and V, laparoscopic cholecystectomy.The shortest period of PI was observed in group V. This period increases notably in group IV (53 h), group II (72 h), and group III (84 h) relative to the control group with (89 h). This reduction in PI time runs parallel with an improvement in the patient's general state of well-being.We concluded that after laparoscopic cholecystectomy PI is nonexistent. Furthermore, this study confirms the correlation between the avoidance of intraabdominal manipulation and the evolution of postoperative ileus.     

Pre-emptive multimodal analgesic bundle with transversus abdominis plane block enhances early recovery after laparoscopic cholecystectomy

BackgroundAs postoperative pain after laparoscopic cholecystectomy may delay recovery and discharge, a multimodal and pre-emptive analgesic approach is necessary. This study demonstrated that a multimodal analgesic bundle improves postoperative recovery, using the Quality of Recovery-40K (QoR-40K) questionnaire during the first 24 h after laparoscopic cholecystectomy.MethodsIn this prospective non-randomized study with two parallel groups, 80 patients undergoing laparoscopic cholecystectomy were allocated into either the multimodal analgesia group or the conventional analgesia group. The multimodal analgesia group received a pre-emptive analgesic bundle (preoperative intravenous administration of paracetamol, ketorolac, and dexamethasone, and a posterior approach to the transversus abdominis plane block), while the conventional analgesia group did not. The primary outcome was the QoR-40K score during the first 24 h after surgery. Secondary outcomes were the peak visual analog scale pain score at rest and the incidence rates of rescue analgesic use and nausea/vomiting during the first 24 h after surgery.ResultsThe QoR-40K score was higher in the multimodal analgesia group than in the conventional analgesia group (196 [190–199] vs. 182 [172–187], p < 0.001). The peak visual analog scale pain score was significantly lower in the multimodal analgesia group than in the conventional analgesia group. Multimodal analgesia also reduced the incidence rates of rescue analgesic use and postoperative nausea/vomiting (22.5% [95% CI, 9.6–35.4%] vs. 55.0% [39.6–70.4%], p = 0.003), compared to conventional analgesia.ConclusionsMultimodal analgesia significantly improves the quality of early postoperative recovery after laparoscopic cholecystectomy, as shown by the QoR-40K score.     

静脉低剂量氯胺酮超前镇痛对腹腔镜胆囊切除术后苏醒和疼痛的影响

目的 观察氯胺酮切皮前给药对腹腔镜胆囊切除术(LC)后苏醒和疼痛的影响.方法 全麻下行LC患者80例,随机均分为两组:对照组采用雷米芬太尼复合丙泊酚麻醉;研究组在切皮前加用小剂量氯胺酮0.3 mg/kg.采用SS和VRS评分评估对苏醒时间和苏醒期躁动情况.结果 两组呼吸恢复时间、睁眼时间、拔管时间差异无统计学意义.研究组苏醒期躁动、镇痛、镇静效果显著优于对照组(P<0.05).结论 静脉低剂量氯胺酮超前镇痛用于LC术后苏醒快,术后疼痛轻,苏醒期躁动少.     

切口浸润麻醉复合帕瑞昔布静注用于腹腔镜胆囊切除术后镇痛

目的 探讨切口浸润麻醉复合帕瑞昔布对腹腔镜胆囊切除术(LC)后内脏痛的镇痛效果.方法 60例择期行LC患者随机均分为帕瑞昔布组(P组)、腹腔内局麻组(B组)和对照组(C组).P组于手术结束前约30 min静脉注射帕瑞昔布40 mg;B组于胆囊切除后在腹腔内喷洒0.25%布比卡因30 ml;C组于手术结束前约30 min静脉注射生理盐水.采用VAS评分记录患者术后1、4和24 h时内脏痛以及镇痛药的用量.结果 术后1、4 h时,P组的内脏痛VAS评分显著小于C组(P相似文献   

右美托咪定用于预防腹腔镜胆囊切除术后恶心呕吐的效果

目的观察右美托咪定预防腹腔镜胆囊切除术后恶心呕吐的效果。方法选择择期行腹腔镜胆囊切除术的患者70例,男17例,女53例,年龄20~65岁,ASAⅠ或Ⅱ级。随机分为两组:右美托咪定组(R组)和地塞米松组(D组),每组35例。R组于麻醉诱导前静脉注射右美托咪定,背景剂量为0.5μg/kg,10min内注射完毕,后以0.5μg·kg~(-1)·h~(-1)维持输注。D组给予地塞米松8mg静脉注射。观察患者入室(T_1)、插管前(T_2)、插管后5min(T_3)、手术开始后5 min(T_4)、手术开始后30min(T_5)、缝皮时(T_6)、拔管后5min(T_7)的血压和心率。记录术中七氟醚的吸入浓度、停七氟醚至拔管的时间、手术时间及麻醉时间。观察患者8、24、48h内有无发生恶心呕吐。结果两组患者术后8、24、48h的恶心发生率和呕吐发生率差异无统计学意义。T2~T7时R组HR明显低于D组(P0.05),两组间MAP差异无统计学意义。结论与静脉注射地塞米松8mg比较,静脉注射右美托咪定负荷量0.5μg/kg(10min),维持量0.5μg·kg~(-1)·h~(-1),对减少腹腔镜胆囊术后恶心呕吐的发生有相同的效果。     

椎板后路阻滞对腹腔镜肾切除术患者术后镇痛的影响

目的观察椎板后路阻滞(retrolaminar block, RLB)对腹腔镜肾切除术患者术后镇痛效果及术后早期恢复的影响。方法腹腔镜肾切除术患者60例,男31例,女29例,年龄18～65岁,ASAⅠ或Ⅱ级,采用随机数字表法分为两组,每组30例:RLB组(R组)与局部浸润组(L组)。R组于全麻诱导后在超声引导下于术侧行RLB,L组于手术结束时行局部浸润麻醉,两组局麻药皆采用0.4%罗哌卡因30 ml。两组术中均行静-吸复合麻醉,术后行舒芬太尼PCIA。记录术后拔管时间、PACU停留时间、镇痛泵有效按压次数和首次下床活动时间。结果 L组拔管时间、PACU停留时间明显长于R组(P0.05),术后24、48 h L组镇痛泵有效按压次数明显多于R组(P0.05),首次下床活动时间明显长于R组(P0.05)。结论与局部浸润比较,椎板后路阻滞可为腹腔镜肾切除术患者提供有效术后镇痛,并有利于术后恢复。     

Irrigation with bupivacaine at the surgical bed for postoperative pain relief after laparoscopic cholecystectomy

Purpose:

The aim of this study was to evaluate the effect of bupivacaine irrigated at the surgical bed on postoperative pain relief in laparoscopic cholecystectomy patients.

Methods:

This study included 60 patients undergoing elective laparoscopic cholecystectomy who were prospectively randomized into 2 groups. The placebo group (n=30) received 20cc saline without bupivacaine, installed into the gallbladder bed. The bupivacaine group (n=30) received 20cc of 0.5% bupivacaine in at the same surgical site. Pain was assessed at 0, 6, 12, and 24 hours by using a visual analog scale (VAS).

Results:

A significant difference (P=.018) was observed in pain levels between both groups at 6 hours postoperatively. The average analgesic requirement was lower in the bupivacaine group, but this did not reach statistical significance.

Conclusions:

In our study, the use of bupivacaine irrigated over the surgical bed was an effective method for reducing pain during the first postoperative hours after laparoscopic cholecystectomy.     

布比卡因阻滞对腹腔镜胆囊切除术后超前镇痛的比较研究

目的探讨躯体-内脏神经阻滞对腹腔镜胆囊切除术后超前镇痛效果. 方法病人随机分为4组,每组25例,A组(躯体阻滞组)在切皮前以0.25%布比卡因25 ml(含1∶200 000肾上腺素)进行切口周围浸润;B组(内脏阻滞组)在气腹后立即以0.25%布比卡因35 ml腹腔内喷洒;C组(躯体-内脏联合阻滞组)进行A组和B组综合处理;D组(对照组)不予处理.在术后1、2、3、6、12、24、48 h分别评估疼痛强度、部位和恶心情况. 结果术后12 h内,D组切口痛明显强于其它部位疼痛(P<0.05).A、C组在术后6 h内疼痛强度和镇痛药物需求量比B、D组明显减少(P<0.05). 结论腹腔镜胆囊切除术后疼痛以切口痛为主,术前躯体-内脏神经阻滞处理能明显减轻术后早期切口痛,但对腹内痛、肩部痛的镇痛效果并不比单用躯体阻滞更好.术前布比卡因切口躯体神经阻滞值得推荐.     

罗哌卡因联合地塞米松腹腔内喷洒对腹腔镜胆囊切除术后疼痛的影响

目的探讨罗哌卡因联合地塞米松腹腔内喷洒对腹腔镜胆囊切除术(LC)后疼痛的影响。方法择期全凭静脉麻醉下行LC患者75例,随机均分为三组,建立气腹后向腹腔胆囊床分别喷洒生理盐水30ml(C组)、0.5%罗哌卡因30ml(R组)或0.5%罗哌卡因30ml复合地塞米松10mg(D组)。记录患者术后4、24、48h的切口、内脏、肩部静息和活动时VAS评分、术后恶心呕吐(PONV)的分级和术后追加镇痛药情况。结果 (1)与C组相比,D组患者术后24h和48h的切口静息和活动时VAS评分均明显降低(P<0.01),R组患者仅术后24h的切口静息和活动时VAS评分明显降低(P<0.05或P<0.01);与R组相比,D组患者术后24h和48h的切口静息和活动时VAS评分均明显降低(P<0.01)。(2)与C组相比,R、D组术后4h和24h的内脏静息和活动时VAS评分均明显降低(P<0.01),D组术后24h和48h的肩部静息和活动时VAS评分均明显降低(P<0.01);与R组相比,D组术后48h的肩部静息和活动时VAS评分均明显降低(P<0.05)。结论罗哌卡因联合地塞米松腹腔内喷洒可增强罗哌卡因的术后镇痛效果和延长镇痛时间,但对术后早期(术后4h)切口痛缓解不明显。