罗哌卡因和利多卡因在腹股沟疝修补术区域阻滞麻醉中的比较  

Comparison of ropivacaine and lidocaine in their use as field block anaethesia during and after inguinal hermia repair

作　　者：国永生[1] 宋栋达[1] 张仲良[1] 张忠涛[1] 

机构地区：[1]首都医科大学附属北京友谊医院普外科,北京100050

出　　处：《国际外科学杂志》2010年第6期394-397,共4页International Journal of Surgery

摘　　要：目的 比较分别用罗哌卡因、利多卡因区域阻滞麻醉腹股沟疝手术的术中麻醉和术后镇痛效果.方法 采用随机、双盲、对照试验设计,选择ASA Ⅰ-Ⅲ级单侧腹股沟疝手术患者100例,随机分为罗哌卡因组和利多卡因组,每组50例,分别用0.75%罗哌卡因30 mL或1%利多卡因40 mL进行区域阻滞麻醉,采用巴德公司4700平片做李金斯坦术式腹股沟疝修补术.记录术后24 h内从注射研究药物至首次服用镇痛药的间隔时间和补充镇痛药总量.术中、术后伤口疼痛程度,以及日常活动问卷评分.结果 罗哌卡因组和利多卡因组服用镇痛药的时间间隔分别为22.35 h和15.05 h,组间差异无统计学意义（X2=0.191,P〉0.05）,但罗哌卡因组较对照组长7.3 h,用Cox回归模型分析,HR=0.888,（95%CL：0.521～1.514）,即罗哌卡因组至首次服用补充镇痛药的间隔时间较利多卡因组延长11.2%.手术后第2小时静息时伤口疼痛评分、日常活动能力问卷总分和第4小时移动时疼痛单项评分,罗哌卡因组均低于利多卡因组,两组之间统计检验均有显著性差异（P〈0.05）.两组均未观察到不良事件.结论 0.75%罗哌卡因区域阻滞麻醉下行腹股沟疝修补术术中麻醉及术后镇痛效果好,镇痛时间长,安全性好,是腹股沟疝手术区域阻滞麻醉的理想药物.Objective To compare the anesthesia and analgesic effect of ropivacaine to lidocaine during and after inguinal hernia repair field.Methods The study was designed as a single-centre,double blind,controlled trial,randomized with two parallel groups.One hundred males scheduled for inguinal hernia repair as day surgery under field block would be eligible to participate and then be randomized to receive field block using 0.75% ropivacaine 30 mL or 1%lidoeaine 40 mL.During the first 24 hours after the start of infiltration,assessments of the time from study drus administration to the first request of additional analgesics,wound pain at rest and on mobilization using NRS,as well as an evaluation of patients＇ability to perform day-to-day activities were made.Wound healing would be judged by the assessor as normal or abnormal on day 7 after surgery.Results Median time from study drug administration to the first request of additional analgesics waft,22.4 hours in ropivaeaine group and 15.1 hours in lidocaine group respectively.Although there was no statistically significant treatment difference between groups（P〉0.05）,clinically relevant differences could be seen in favour of ropivacaine.The HRs（hazard rato） for this variable using Cox regression model showed a tendency favoring ropivacaine in increasing the time from study drug administration to the first request of additional analgesics when comparing ropivacaine group and lidocaine group,with an HR of 0.888（95%CI：0.521-1.514;P〉0.05）,corresponding to a risk reduction of 11.2%.Postoperative wound pain scores at rest at 2nd hour was lower in ropivacaine group than lidocaine group（P〈0.05）.Pestoperative wound pain scores upon mobilization in 4th hour and the total scores of day-to-day activity questionnaire in 4th hour were lower in ropivacaine group than that of lidocaine group（P〈0.05）.No any adverse effects were found in the two groups,and wound healing was normal in all patients in the two groups 7 days after surgery.Conclusion Ropivacaine p

关 键 词：罗哌卡因 区域阻滞麻醉 腹股沟疝 

分 类 号：R614[医药卫生—麻醉学]