不同局部麻醉药物用于烧伤手术头部取皮止痛的效果研究

目的 研究低浓度罗哌卡因、布比卡因、利多卡因在烧伤手术患者头部取皮后的镇痛效果.方法 选择使用头部取皮法进行烧伤后切削痂植皮的患者84例,取头皮前橡皮带环扎止血后,随机分为4组,各21例.其中常规对照组(C组)按既往常规方法在头皮下注入含1/20万的肾上腺素生理盐水200 mL进行头皮下扩张,罗哌卡因组(R组)给予0.05％罗哌卡因200 mL进行头皮下局部麻醉并扩张头皮,布比卡因组(B组)给予0.188％布比卡因头皮下局部麻醉,利多卡因组(L组)给予0.1％利多卡因头皮下局部麻醉.分别于麻醉开始前(T0)和手术结束患者清醒后20 min(T1)、5 h(T2)和10 h(T3)时采用肌肉活动评分法(MAAS)进行意识状态评价,并采用视觉模糊评分(VAS)对头部及躯体创面分别进行疼痛评估,全程监测心率、血压等生命体征进行安全性评价.结果 4组患者均安全度过围手术麻醉期,其中R组患者在3个时间点VAS评分均明显低于其余两组(P＜0.05).结论 头皮下低浓度罗哌卡因注射更适合应用于头皮取皮后的患者镇痛.

Analgesia Efficacy of Different Local Anesthetics in Harvesting Grafts from Scalp of Burn Patients

Objective To investigate the analgesic effect of low concentrations of ropivacaine, bupivacaine and lidocaine in burn patients after harvesting grafts from scalp. Methods Eighty- four patients with harvesting grafts from the scalp after burn, whom randomly divid- ed into 4 groups （n=21） after rubber belt ring ligation hemostasis. The routine control group（C） was injected normal saline 200 mL containing 1/200 000 adrenaline under the scalp for the subscalp dilation; the ropivacaine group（R） was given 0.05% ropivacaine 200 mL for subscalp local anesthesia; the bupivacaine group （B） was given 0. 188% bupivacaine for subscalp local anesthesia and the lido- caine group（L） was given 0.1% lidocaine for subscalp local anesthesia. The motor activity assessment scale（MAAS） was adopted to perform the conscious state evaluation before anesthesia（T0） and at 20 min（T~）, 5 h（T2）, 10 h（%） after the end of operation and pa- tient＇s awaking. Moreover, the visual analogue scale（VAS） was adopted to conduct the pain evaluation on the head and body wound. The vital signs of the heart rate and blood pressure, etc. were also performed the whole course monitoring for the assessment of se- curity. Results All 4 groups passed the perioperative period safely. Among them, the VAS scores at 3 timepoints in the group R were significcantly lower than those in the other 2 groups. Conclusion Low concentration of ropivacaine injected under the scalp is more suitable for analgesia in harvesting grafts from scalp.