罗哌卡因和利多卡因在腹股沟疝手术中的效果对比

目的探讨罗哌卡因和利多卡因在腹股沟疝手术中局部麻醉的效果差异。方法选择2018年1月至2019年11月在马鞍山中心医院接受腹股沟疝无张力修补手术治疗的患者90例。30例使用利多卡因局部麻醉的患者作为A组,30例使用利多卡因联合0.375%罗哌卡因的患者作为B组,30例使用利多卡因联合0.75%罗哌卡因的患者作为C组。对比3组的血流动力学指标平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO₂)]、手术情况相关指标(手术耗时、失血量、住院时间)、麻醉效果相关指标麻醉起效时间、麻醉持续时间、术后患者的视觉模拟评分(VAS)]、术后不良反应。结果3组患者在麻醉前、麻醉后1、5、10 min的MAP、HR、SpO₂数据差异无统计学意义(P>0.05)。3组患者的手术耗时、失血量数据差异无统计学意义(P>0.05)。B组和C组的住院时间短于A组(P<0.05)。B组和C组的麻醉起效时间长于A组(P<0.05)。C组的麻醉持续时间长于B组,B组的麻醉持续时间长于A组(P<0.05)。C组在术后1、3、6、9 h的VAS评分低于B组,B组在术后1、3、6、9 h的VAS评分低于A组(P<0.05)。3组在术后12、24 h的VAS评分差异无统计学意义(P>0.05)。3组的术后不良反应差异无统计学意义(P>0.05)。结论对于接受腹股沟疝无张力修补手术的患者,采用含有利多卡因或者罗哌卡因的局部麻醉方法均可以保证手术过程中的血流动力学稳定以及麻醉效果。利多卡因的起效时间更快,罗哌卡因的镇痛效果维持时间更长,使用浓度为0.75%罗哌卡因与利多卡因联合使用,患者可获得更好的术后镇痛效果,且用药的安全性良好。

Comparison of the effects of local anesthesia with ropivacaine and lidocaine in inguinal hernia surgery

Objective To explore the difference in the effect of local anesthesia between ropivacaine and lidocaine in inguinal hernia surgery.Methods From January 2018 to November 2019,90 patients who underwent tension-free inguinal hernia repair at Ma'anshan Central Hospital were selected.Thirty patients underwent local anesthesia with lidocaine served as group A,30 patients underwent local anesthesia with lidocaine combined with 0.375%ropivacaine as group B,and 30 patients underwent local anesthesia with lidocaine combined with 0.75%ropivacaine as group C.The hemodynamic indexes of the 3 groupsmean arterial pressure(MAP),heart rate(HR),blood oxygen saturation(SpO₂)before anesthesia,1 min after anesthesia,5 min after anesthesia,10 min after anesthesia],related indexes of the operation condition(operating time,blood loss,length of hospital stay),anesthesia effect related indicatorsanesthesia onset time,anesthesia duration,postoperative visual analogue scale(VAS)at 1,3,6,9,12,and 24 hours],postoperative adverse reactions were compared among the three groups.Results The differences in MAP,HR and SpO₂ data of the three groups of patients before anesthesia,1 minute after anesthesia,5 minutes after anesthesia,and 10 minutes after anesthesia were not statistically significant(P>0.05).There were no statistically significant differences in operating time and blood loss among the three groups of patients(P>0.05).The hospital stay of group B and group C was shorter than that of group A(P<0.05).The onset time of anesthesia in group B and group C was longer than that in group A(P<0.05).The duration of anesthesia in group C was longer than that in group B,and the duration of anesthesia in group B was longer than that in group A(P<0.05).The VAS score of group C at 1,3,6 and 9 hours after operation was lower than that of group B,and the VAS score of group B at 1,3,6,and 9 hours after operation was lower than that of group A(P<0.05).There was no significant difference in the VAS score data among the 3 groups at 12 and 24 hours after operation(P>0.05).The difference in postoperative adverse reaction data among the 3 groups was not statistically significant(P>0.05).Conclusion For patients undergoing tension-free inguinal hernia repair,the use of local anesthesia containing lidocaine or ropivacaine can ensure hemodynamic stability and anesthesia during the operation.Lidocaine has a faster onset time,while the analgesic effect of ropivacaine lasts longer.The combined use of ropivacaine and lidocaine at a concentration of 0.75%can provide patients with better postoperative analgesia,and the medication safety is good.