罗哌卡因切口预注射联合曲马多对腹腔镜下胆囊切除术后疼痛的影响

目的评估罗哌卡因切口预注射联合曲马多对腹腔镜下胆囊切除术（laparoscopic cholecystectomy,LC）术后疼痛的影响。方法选取2010年6月2011年4月行择期LC患者120例,年龄18～65岁,美国麻醉师协会Ⅰ～Ⅱ级,采用完全随机的设计分组：0.75%罗哌卡因10mL切口注射＋术毕静脉注射曲马多（2mg/kg）组（A组,n=30）;生理盐水10mL切口注射＋术毕静脉注射曲马多（2mg/kg）组（B组,n=30）;0.75%罗哌卡因10mL切口注射＋术毕静脉注射生理盐水10mL组（C组,n=30）;生理盐水组（D组,n=30）。术后2、4、6、12、24h分别评估右上腹部、右肩背部和腹壁切口疼痛进行视觉模拟评分（visual analog scale,VAS）。结果右上腹部及右肩背部疼痛VAS比较：与D组相比,A、B组VAS评分明显减少（P〈0.05）,而C组无明显统计学差异（P〉0.05）;B组与A组相比,2～24hVAS评分明显增加（P〈0.05）;C组与A组相比,2～24hVAS评分增高（P〈0.01）。腹壁切口疼痛VAS比较：与D组相比,A、B、C组VAS评分明显减少（P〈0.05）;B组与A组相比,2～24hVAS评分明显增加（P〈0.05）;C组与A组相比,2～24hVAS评分显著增高（P〈0.01）。结论腹腔镜胆囊切除术术前切口罗哌卡因预注射-术毕曲马多静脉注射对减轻术后疼痛有良好效果。

Preincisional Ropivacaine plus Tramadol Intravenous Injection for Postoperative Pain Relief after Laparoscopic Cholecystectomy

Objective To evaluate the effects of preincisional ropivacaine plus tramadol intravenous injection on postoperative pain relief after laparoscopic cholecystectomy（LC）.Methods One hundred and twenty patients aged between 18 and 65 years old with an ASA score from Ⅰ to Ⅱ who underwent elective laparoscopic cholecystectomy from June 2010 to April 2011 comprised this study.The patients were randomly divided into four groups with 30 in each group.Patients in group A had an infusion of 0.75% ropivacaine（10 mL） at the beginning of LC plus tramadol（2 mg/kg） intravenous injection at the end.Group B patients had an infusion of normal saline 0.9%（10 mL） at the beginning of LC plus tramadol（2 mg/kg） intravenous injection at the end.Patients in group C had an infusion of 0.75% ropivacaine（10 mL） at the beginning of LC plus normal saline 0.9%（10 mL） intravenous injection at the end.Group D（control group） patients had neither ropivacaine nor tramadol infusion.Pain in the right upper abdomen,right shoulder tip and abdominal incision were assessed at hour 2,4,6,12,and 24 postoperatively using a visual analog score（VAS）.Results Right upper abdomen and right shoulder tip pain VAS comparison： significantly lower pain scores were observed in group A and B（P0.05） than in group D（P0.05）.Group A had significantly lower pain scores than group B（P0.05） and C（P0.01） at postoperative hours 2,4,6,12,and 24.Abdominal incision pain VAS comparison： VAS scores were significantly lower in group A,B and C than in group D（P0.05）.Group A had significantly lower pain scores than group B（P0.05） and C（P0.01） at postoperative hours 2,4,6,12,and 24.Conclusion Preincisional ropivacaine at the beginning of LC combined with tramadol intravenous injection at the end can effectively alleviate postoperative pain after laparoscopic cholecystectomy.