布托啡诺预防瑞芬太尼麻醉后早期急性疼痛不同时机的临床观察

目的比较不同时间给予布托啡诺对预防瑞芬太尼麻醉后早期急性疼痛的效果。方法选择全身麻醉下行腹腔镜妇科手术的患者80例,全麻诱导后以丙泊酚、瑞芬太尼维持麻醉。随机均分为4组：B1组在手术结束前30min静脉注射布托啡诺0.02mg/kg,B2组在手术结束时给予布托啡诺0.02 mg/kg,B3组在气管拔管后给予布托啡诺0.02 mg/kg,C组为对照组静注相同剂量的生理盐水。记录手术结束到患者恢复自主呼吸的时间、睁眼时间、气管拔管的时间,以及苏醒拔管后30min每隔10 min的疼痛VAS评分及Ramsay评分,苏醒后30min内VAS评分≥5者视为镇痛失败。结果 4组患者手术结束后自主呼吸恢复时间、气管拔管时间差异均无统计学意义。苏醒拔管后30min内B2组VAS评分较低,且镇痛失败率明显低于B1、B3两组（P〈0.05）。结论预防瑞芬太尼麻醉后早期急性疼痛,手术结束时给予布托啡诺的效果优于提前30min给药和拔管后给药,且不影响苏醒时间。

The clinical observation of Butorphanol for early postoperative acute pain control after remifentanil anesthesia

Objective To evaluate the effects of Butorphanol for early postoperative acute pain control after remifentanil anesthesia.Method Eighty patients undergoing gynecologic laparoscopic surgery elective surgery were randomly divided equally into four groups.The patients received butorphanol 0.02mg/kg 30min before the end of surgery in group B1,immediately after surgery in group B2,and after tracheal extubation in group B3 respectively.Time for recovery of spontaneous respiration,time for eyes open and time for tracheal extubation after the end of surgery were recorded.The VAS score and Ramsay score were recorded in 10,20,30 minutes after extubation.Postoperative analgesia was failure when the VAS score ≥ 5 in 30 minutes after extubation.Results Time for recovery of spontaneous respiration and time for tracheal extubation were similar among the four groups.VAS scores were lower in group B2 than those groups in 30 minutes after tracheal extubation,and the cases with a VAS score≥ 5 were less in group B2（P0.05）.Conclusion To control early postoperative acute pain after remifentanil anesthesia,administration of butorphanol 0.02 mg/kg immediately after surgery is better than 30 min before the end of surgery and after tracheal extubation,and not influence the recovery time of anesthesia.