利用腹腔镜戳孔局部注射布比卡因术后镇痛研究

目的 评价腹腔镜术后戳孔局部注射布比卡因的镇痛效果.方法 选用腹腔镜胆囊切除术后90例患者,随机分为3组,每组30例.布比卡因组:于戳孔局部注射0.25%布比卡因20 ml(50 mg);生理盐水组:于戳孔局部注射生理盐水加ml;镇痛泵组:于术后使用静脉镇痛泵(patientcontrolled intravenous analgesia,PCIA).在麻醉苏醒后2、6、12、24 h分别记录患者安静状态下的镇痛模拟评分(按视觉模拟评分法 visual analogue scale,VAS),同时记录3组患者术后排气时间.结果 3组患者术后均无并发症,布比卡因组患者无相应毒副作用,12 h内镇痛效果优于生理盐水组,尤以6 h内明显(t2h=8.475;t6h=5.356;t12h=3.496,均P＜0.05),与镇痛泵组相比,镇痛效果差异无统计学意义(t2h=1.361;t6h=1.720;t12h=1.682;t24h=1.721,均P＞0.05),镇痛泵组患者的术后排气时间晚于其他两组患者(x224h=5.406,P＜0.05).结论 腹腔镜胆囊切除术后,患者戳孔局部应用布比卡因镇痛效果明显,尤其在术后12 h内,可以降低使用其他镇痛药物的用量,并且不影响术后肠道功能的恢复.

Abstract：

Objective To evaluate analgesic effect of bupivacaine infiltration in trocar incision after laparoscopic surgery.Methods 90 patients were randomly divided into 3 groups after laparoscopic cholecystectomy.In group 10.25% bupivacaine 20 ml(50 mg) injection, in group 2 sterile NS 20 ml infiltrated in the muscular fasciae of the trocars, in group 3 patient-controlled intravenous analgesia(PCIA) was used.In 2, 6, 12 and 24 hours after the intervention, the pain intensity was recorded with the use of a Visual Analogue Scale ( VAS), time of flatus passing was recorded as well.Results Patients with bupivacaine or PCIA had statistically significant in pain score compared with patients with NS especially within 12 hours after the surgery (t2h = 8.475; t6h = 5.356; t12h = 3.496, P ＜ 0.05) while the difference was not statistically significant between the 3 groups at 24 hours.The time of passing flatus in group 1 patients with bupivacaine was earlier than with PCIA ( x224h = 5.406, P ＜ 0.05 ) .Conclusions Bupivacaine infiltrated in trocar incision after laparoscopic surgery reduced postoperative pain, and did not disturb peristalsis reflex recovery of the intestines.

Local bupivacaine injection through trocar incision of laparoscopic surgery for postoperative pain control

Objective To evaluate analgesic effect of bupivacaine infiltration in trocar incision after laparoscopic surgery.Methods 90 patients were randomly divided into 3 groups after laparoscopic cholecystectomy.In group 10.25% bupivacaine 20 ml(50 mg) injection, in group 2 sterile NS 20 ml infiltrated in the muscular fasciae of the trocars, in group 3 patient-controlled intravenous analgesia(PCIA) was used.In 2, 6, 12 and 24 hours after the intervention, the pain intensity was recorded with the use of a Visual Analogue Scale ( VAS), time of flatus passing was recorded as well.Results Patients with bupivacaine or PCIA had statistically significant in pain score compared with patients with NS especially within 12 hours after the surgery (t2h = 8.475; t6h = 5.356; t12h = 3.496, P ＜ 0.05) while the difference was not statistically significant between the 3 groups at 24 hours.The time of passing flatus in group 1 patients with bupivacaine was earlier than with PCIA ( x224h = 5.406, P ＜ 0.05 ) .Conclusions Bupivacaine infiltrated in trocar incision after laparoscopic surgery reduced postoperative pain, and did not disturb peristalsis reflex recovery of the intestines.