腹直鞘内注入局麻药用于胆囊切除术后镇痛

目的:观察右腹直肌鞘内注入局麻药对腹直肌切口胆囊切除术后镇痛的效果。方法:于缝合后鞘之后,经切口中央向右钝性将腹直肌与前鞘分离至半月线处,再延此线向上向下将腹直肌外缘与前后鞘的融合处分开至切口全长,经中部分离口垂直向外置硬膜外麻醉导管至尖端在半月线后,绕管缝合分离口。结果:20例成年患者,双盲法经自皮下组织于切口上段引出的导管首次注入0.5％布比卡因10 mL的B组(n=10),注药后(9.0±1.3)min疼痛开始减轻,注药后25 min的视觉模拟评分(VAS)由注药前的10减少了7.25±1.55,镇痛持续时间为(3.75d±0.67)h,分别较注入等量生理盐水的A组(n=10)差异有显著性。B组第2次注药7 mL,与首次注药后皮肤麻木范围均可达T7～T10。所有病例第2次注药开始均每4 h注入0.5％布比卡因7 mL,留管24 h～72 h(45.6±14.5),伤口均Ⅰ期愈合。结论:本方法注药后可能通过同时阻滞后鞘的肋间神经末梢支和经过前鞘的末梢神经分支而有效地减轻胆囊切除术后疼痛。

Postoperative Pain Relief by Bupicaraine in the Rectus Sheaf of Cholecystectomized Patients

Objective to observe analgesic effects of rigional anesthestic injected into right abdominal rectus sheaf on postoperative pain induced by cholecystectomy via rectus incision with double blind method. Method 20 adults , underwent cholecystectomy .were divided into sham control(A group, n=10)and 0. 5 % bupivacaine group(B group.n = 10). After the closing the right posterior rectus sheaf,the hole tip end of a epidural anesthetic tube was introduced through blunt dissociated gap between the anterior rectus sheaf and the abdominal rectus muscle,to make tip of the tube near semilunar line and the center of the insion .along which the same blunt disociation had been done. Other end of the tube was out of the abdominal wall. Result When postopertive pain can not been tolerated , 10 mL normal salt water for A group and 10 mL 0. 5 % bupivacaine were respectively injected into the abdominal rectus sheaf, time of analgesia oneset.visual analogue scale(VAS),and time of persisting analgesia for B group were signifcantly earlier , lower and longer respectively than thoses for A group . From the beginning of second injection 7ml of 0. 5% bupivacaine was samely injected for both A and B group at 4 hour interval . The tube kept 24-72 hour(45. 6±14. 5). The wound infection wasnot seen. Conclusion It is suggested that injection of rigional anesthestic drug into right abdominal rectus sheaf have obviousl effect of analgesia on postoperative pain induced by cholecystectomy via rectus incision and the mechanism may be block end branch of intercostal nerve.