腹壁局麻复合胆囊床浸润麻醉对术后疼痛的影响  

The effect of local abdominal wall anesthesia and gallbladder bed infiltration anesthesia on postoperative pain

作　　者：吕作均[1] 邹学军[1] 佟华丽[1] 简道林[1] 陈小波[2] 曹登科[3] 吴遵元[3] 龚学东[3] 

机构地区：[1]三峡大学仁和医院麻醉科,宜昌市443001 [2]三峡大学人民医院 [3]三峡大学仁和医院普外科,宜昌市443001

出　　处：《临床麻醉学杂志》2011年第4期364-365,共2页Journal of Clinical Anesthesiology

摘　　要：目的探讨气腹前腹壁用罗哌卡因局麻和胆囊床放置含罗哌卡因、芬太尼混合液的明胶海绵对腹腔镜胆囊切除术后疼痛的影响。方法腹腔镜胆囊切除术的患者50例,随机均分为研究组和对照组。研究组采用0.45%罗哌卡因20 ml在腹壁三个打孔处局部麻醉,并于胆囊切除止血后,胆囊床处放置明胶海绵两片(含0.9%的罗哌卡因和0.05 mg芬太尼的混合液5 ml)。对照组除腹壁浸润注射生理盐水外,并在胆囊切除后,静脉给予芬太尼0.05 mg。记录术后1、2、3、6、9和24 h的VAS评分。结果研究组术后各时点静息、运动VAS评分小于对照组(P<0.05)。术后研究组右肩痛发生率、镇痛药使用率明显低于对照组(P<0.05)。结论腹壁局部麻醉和胆囊床放置含罗哌卡因和芬太尼的明胶海绵,对腹腔镜胆囊切除术后的疼痛有减轻作用。Objective To determine the effect of local abdominal wall anesthesia and gallbladder bed infiltration anesthesia on postoperative pain in patients undergoing laparoscopic cholecystectomy （LC）. Methods Fifty patients scheduled for LC were randomly assigned to research group and control group. In research group, 20 ml ropivacaine around the trocar wounds was infused and twoof gelatin sponges soaked with 5 ml 0.9% ropivacaine and 0. 05 mg fentanyl were placed in the cholecyst bed after complete hemostasis of the gallbladder bed. Patients in control group received abdominal wall infiltration with normal saline and 0. 05 mg fentanyl intravenous alter complete hemostasis of the gall bladder bed. The pain intensity was evaluated with VAS scoring at 1,2, 3,6, 9h post-operatively. Results The pain scores were much lower in research group than those in group either at rest or movement （P〈 0. 05）. Rescue analgesic treatment was significantly lower in patients of research group（32%） as compared with that of control group（76%） （P〈0.05）. The incidence of right shoulder pain was significantly lower in control group （20%） than in research group （64%） （P〈0.05）. Conclusion Preincisional local infiltration and the cholecyst bed placed with ropivacaine-and fentanyl-soaked gelatin sponge could significantly relieve postoperative pain in LC.

关 键 词：腹腔镜胆囊切除术 内脏痛 罗哌卡因 芬太尼 浸润麻醉 

分 类 号：R614[医药卫生—麻醉学]