甲磺酸罗哌卡因联合曲马多对瑞芬太尼麻醉下LC术的超前镇痛作用

目的观察局部浸润甲磺酸罗哌卡因联合静注曲马多于靶控输注（TCI）瑞芬太尼麻醉下腹腔镜胆囊切除术（LC）患者超前镇痛效应。方法对60例LC术患者，使用不同药物超前镇痛。60例随机分成局部浸润甲磺酸罗哌卡因（R）、静脉注射曲马多（T）、甲磺酸罗哌卡因联合曲马多（R＋T）三组，各20例，观察三组术后2、4、6、8、12、24、48h时间点视觉模拟评分（VAS）、Ramsay评分、不良反应及不同时段术后镇痛药物使用次数。结果术后2,4、6h内R＋T组VAS评分低于R、T组（P＜0．05）。Ramsay评分各组间差异无显著性（P＞0．05）。各组术后恶心呕吐（PONV）等不良反应发生率差异无显著性（P＞0．05）。0～6h内R＋T组术后患者使用镇痛药物次数少于R、T组（P＜0．05）。结论甲磺酸罗哌卡因联合曲马多可有效用于靶控瑞芬太尼下LC术患者的超前镇痛。

The effect of preemptive analgesia with ropivacaine methaesulfonide combined with ~nadol in patients undergoing laparoscopic cholecystectomy in remifentanil target-controlled infusion anesthesia

Objective To evaluate the effect of preemptive analgesia with local anesthesia by ropivacaine methanesulfonide combined with intravenous injection of tramadol in patients undergoing laparoscopic cholecystectomy in remifentanil target - controlled infusion anesthesia . Methods Sixty ASA Ⅰ～Ⅱ patients undergoing laparoscopic cholecystectomy were randomly derided into 3 groups with 20 patients in each group ： （ 1 ） local anesthesia with ropivacaine methanesulfonide group（R） ; （2）intravenous injection with tramadol group（T） ; （3）ropivacaine methanesulfonide combined tramadol group（R ＋ T）. Visual analog scale（VAS）, Ramsay score, postoperative adverse reaction and the frequency af using analgesic on 2,4,6,8,12,24,48h poswperative time were recorded . Results Statistically significant decrease of VAS only in group R ＋ T was observed at 2,4,6 h after operation compared with that in group R or T （ P 〈 0.05）. There was no significant difference among groups on Ramsay score （ P 〉 0.05）. There also was no significant difference among groups on the incident of adverse reaction such as postoperative nausea and vomiting（PONV） and the others（ P 〉〉 0.05）. The frequency of using analgesic was lower than that in group R or T at 0 ～ 6h after operatiou（ P 〈 0.05）. Conclusion Local anesthesia with ropivacaine methanesulfonide combined with intravenous injection tramadol can effectively offer preemptive analgesia in patients undergoing laparosoopic cholecystectomy in remifentanil target - controlled infusion anesthesia.