多瑞吉联合罗哌卡因用于腹腔镜胆囊切除术后镇痛的临床研究

目的 研究多瑞吉联合罗哌卡因局部浸润用于腹腔镜胆囊切除术后镇痛的效能和安全性.方法 择期全麻腹腔镜胆囊切除手术患者120例,均分为3组.罗哌组(A组):缝合切口前向胆囊床喷洒及切口局部浸润0.5%罗哌卡因;多瑞吉组(B组):入手术室时胸前贴多瑞吉贴膜;联合组(C组):入手术室时胸前贴多瑞吉,缝合切口前向胆囊床喷洒及切口局部浸润0.5%罗哌卡因.术中3组均采用气管插管控制呼吸异丙酚、芬太尼静脉麻醉,术后持续监测血氧饱和度、呼吸、血压、心电图,进行VAS评分、Ramsay评分,观察有无恶心、呕吐、瘙痒、眩晕、呼吸抑制等副反应.结果 镇痛效果:A组术后6 h内、B组术后6～48 h内镇痛效果满意,C组在术后48 h内镇痛效果满意;呼吸影响:3组病例均未出现血氧饱和度低于90%;副反应:恶心、呕吐发生率3组相似.瘙痒、眩晕发生率B、C组略高于A组,但无统计学差异(P＞0.05).结论 多瑞吉联合罗哌卡因局部浸润用于腹腔镜胆囊切除术术后镇痛安全有效.

Pain control after laparoscopic cholecystectomy

Objective To evaluate the safety and efficiency in pain control after laparoscopic cholecystectomy of Fentaynyl transdermal system combined with local infiltration of ropivacaine. Methods A hundred and twenty patients ready for selective laparoscopic cholecystectomy were randomly divided into three groups. Ropivacaine group underwent cholecyst bed surface insufflation and local incision infiltration with 0.5% ropivacaine before incision suture; Fentanyl transdermal system group applied Fentanyl transdermal system onto their chests immediately after entering operation room; Combination group underwent both procedures of ropivacaine group and Fentanyl transdermal system group. All patients experienced general anesthesia with fentanyl-propofol. SPO2, RR, ECG and blood pressure were monitored continuously after surgery. VAS score and Ramsay score were evaluated. The incidence of nausea, vomiting, pruritus and vertigo was observed. Results The analgesic effect was satisfactory in ropivacaine group in postoperative 6 h, in Fentanyl transdermal system group in postoperative 6-48 h, and in postoperative 48 h in combination group. The evidence of respiratory depression was found in no patients. There was no difference among three groups in the incidence of nausea and vomiting. Incidence of pruritus and vertigo in Fentanyl transdermal system group and combination group was higher than ropivacaine group, but without statistical difference (P>0.05). Conclusion Combination of Fentanyl transdermal system and local infiltration of ropivacaine is safe and efficient in analgesia after laparoscopic cholecystectomy.