腹腔内布比卡因和芬太尼对腹腔镜术后镇痛效果  

Intraperitoneal Application of Bupivacaine plus Fentanyl for Pain Relief after Laparoscopic Cholecystectomy

作　　者：李华 庄小凤[2] 张燕影[2] 

机构地区：[1]上海市徐汇区大华医院麻醉科,上海200231 [2]复旦大学附属中山医院麻醉科,上海200032

出　　处：《中国临床医学》2004年第4期643-644,共2页Chinese Journal of Clinical Medicine

摘　　要：目的 :评价腹腔内给予局麻药物和芬太尼对腹腔镜胆囊切除术后镇痛效果。方法 :腹腔镜胆囊手术结束 ,90例病人被随机分配到 3组 ,组 1在腹腔内注射生理盐水 30ml;组 2在腹腔内注射 0 .2 5 %布比卡因 30ml;组 3腹腔内注射 30ml0 .2 5 %布比卡因 +5 0 μg芬太尼。组 2在腹腔内注射完毕后 ,静脉注射芬太尼 5 0 μg ,组 1和组 2则注射 2ml生理盐水。分别在术后的 1、2、6、12、2 4h记录病人在安静和咳嗽状态下的模拟镇痛评分、曲马多的累积用量、曲马多的PCA追加用量和各种不良反应的发生。结果 :除了术后 2h ,在安静和咳嗽状态下 ,组 3腹腔内接受布比卡因和芬太尼药物对切口和腹腔内疼痛的镇痛效果均较其余两组好 (P <0 .0 5 ) ,组 3肩膀疼痛的发生率较其余两组明显降低 (P <0 .0 5 ) ,在术后的 12h ,曲马多的PCA追加累计剂量组2较组 1明显降低 (P <0 .0 5 ) ,3组的相后 2 4h曲马多用量分别是 (4 0 6± 10 4mg ,6 4 2± 12 3mg和 6 6 3± 12 6mg ;P <0 .0 5 )。结论 :在腹腔镜胆囊切除术后的病人 ,腹腔内给与局麻药和芬太尼的术后镇痛效果较单纯使用腹腔内局麻药效果更加明显 ,同时可以明显减少术后肩膀疼痛的发生 。Objective: This study was aimed at assessing the analgesic effect of the intraperitoneal administration of bupivacaine and fentanyl in patients undergoing laparoscopic cholecystectomy. Methods: At the end of laparoscopic cholecystectomy, in a double-blind, randomized manner, 90 patients were divided into 3 groups. Group 1, physiological saline 30mL; Group 2, bupivacaine 0.25% 30mL; Group 3, bupivacaine 0.25% 30mL plus fentanyl. In addition, Group 2 received 50(g intravenous (i.v.) fentanyl in 2mL saline, and Groups 1 and 3, 2mL saline intravenously. Patient postoperative pain was evaluated using a visual analogue scale. The postoperative analgesic requirement, pain, supplemental analgesic consumption and side-effects were recorded for 24 h. Results: There were no differences between the three groups regarding pain scores (at rest and coughing) during the study except in the first 2 h, when scores were lower for patients receiving intraperitoneal bupivacaine plus fentanly (P<0.05). However, the cumulative doses of tromadol were also lower in Group 3 than in Groups 1 and 2 over the entire study (406 ± 104 mg vs. 642 ± 123 and 663 ± 126 mg; P< 0.05). Conclusion:The intraperitoneal administration of bupivacaine 0.25% plus intravenous fentanyl reduced the analgesic requirements. The combination of intraperitoneal bupivacaine 0.25% plus fentanyl was more effective for treatment of pain after laparoscopic cholecystectomy.

关 键 词：布比卡因 芬太尼 腹腔镜 术后镇痛 腹腔内给药 

分 类 号：R614[医药卫生—麻醉学]