腹腔镜胆囊切除术后不同浓度罗哌卡因腹横肌平面阻滞镇痛效果的随机对照研究

目的 对比不同浓度的罗哌卡因腹横肌平面(transversus abdominis plane,TAP)阻滞用于腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)患者术后的镇痛效应、整体转归和不良反应.方法 选择兰州大学第二医院2015年1 1月至2016年5月择期行LC的60例患者,采用随机数字表法分为0.250％、0.375％浓度罗哌卡因组,每组30例.两组患者均接受全凭静脉麻醉和靶控输注(targetcontrolled infusion,TCI)下诱导和术中维持.手术开始前,实施双侧超声引导的TAP阻滞;手术结束前给予舒芬太尼维持镇痛,转运至麻醉后恢复室和病房后,患者有疼痛主诉时给予帕瑞昔布钠和舒芬太尼镇痛.分别记录术后首次使用额外镇痛药的时间、围术期阿片类药物和帕瑞昔布钠使用总量、术后不同时段的疼痛数字评分(numeric rating scale,NRS)以及相关的不良反应.结果 LC术后两组接受不同浓度的罗哌卡因行TAP阻滞的患者术中瑞芬太尼使用量比较,差异有统计学意义(P＜0.05),术后镇痛药用量、各时间点疼痛评分和相关的不良反应比较,差异没有统计学意义(P＞0.05).结论 低浓度罗哌卡因与高浓度相比镇痛效果相当,建议降低浓度以提高TAP阻滞的安全性.

Analgesic efficiency of different dose ropivacaine on transversus abdominis plane block after laparoscopic cholecystectomy: a randomized control trial

Objective To compare the analgestic efficacy on transversus abdominis plane (TAP) block,overall rehabilitation and relative adverse reactions of different doses of ropivacaine in patients after laparoscopic cholecystectomy (LC).Methods A total of 60 patients undergoing elective LC in our hospital from November 2015 to May 2016 were prospectively recruited in this study.They were randomly divided into 2 groups,and received 0.250％ and 0.375％ ropivacaine respectively for bilateral TAP block.Total intravenous anesthesia (TIVA) was adopted in all patients,and target controlled infusion (TCI) was carried out through the anesthetic induction and maintained intra-operatively.A skilled anesthesiologist performed the bilateral subcostal TAP block under ultrasound guidance before the surgical incision was made.After operation,all patients were given sulfentanil to maintain the pain relief.The patients complaining of pain,in the postanesthetic care unit and the surgical ward,were injected additional analgesic parocoxib and sulfentanil.Afterwards,the following results of all patients were recorded:the first time to receive the additional analgesic,total dose of opioids and parocoxib during the perioperative time,scores numeric rating scale (NRS) for pain at different intervals and relative adverse effects.Results Significant difference was found in the dose of remifentanil between the patients receiving different doses of ropivacaine in the bilateral TAP block (P ＜ 0.05).But there were no differences in the total amounts of opioids and parocoxib,scores of NRS at different intervals and relative adverse effects between the 2 groups (P ＞ 0.05).Conclusion Low dose ropivacaine exerts similar analgestic efficacy when compared with high dose,so it is recommended to improve its safety for TAP block.