妇科腹腔镜手术碳酸利多卡因盆腔冲洗联合创口浸润与氟比洛芬酯术后镇痛效果的比较  

Comparison of intrapelvic irrigation and incision infiltration with lidocaine carbonate and intravenous flurbiprofen axetil for postoperative pain after gynecological laparoscopy

作　　者：聂玉艳[1] 罗青妍[1] 黄绍强[1] 董苏林 

机构地区：[1]复旦大学附属妇产科医院麻醉科,上海市200009

出　　处：《临床麻醉学杂志》2014年第8期733-736,共4页Journal of Clinical Anesthesiology

摘　　要：目的 比较妇科腹腔镜手术碳酸利多卡因盆腔冲洗联合创口浸润与氟比洛芬酯术后镇痛的效果.方法 择期全麻下妇科腹腔镜手术患者60例,采用随机数字表法分为三组.F组：手术结束静脉注射氟比洛芬酯100 mg;L组：手术结束用0.35％碳酸利多卡因100ml冲洗盆腔,并用0.87％碳酸利多卡因10 ml对腹部创口局部浸润;FL组：联合应用F组和L组的方法.在PACU病房中分别采用舒芬太尼5μg和曲马多100mg补充镇痛,必要时可重复注射.记录术后1、4、8、12、24 h的VAS疼痛评分,及术后镇痛药的用量和第一次肛门排气的时间.记录术后恶心呕吐的发生率以及口周麻木、眩晕和耳鸣等不良反应.结果 术后1～24 h FL组VAS疼痛评分明显低于F组和L组（P＜0.05）,术后1hL组VAS疼痛评分明显低于F组（P＜0.05）.F组和L组分别有4例和5例患者使用了舒芬太尼,F组有1例使用了曲马多,FL组术后无患者需要补充镇痛.三组患者术后恶心呕吐的发生率差异无统计学意义.结论 妇科腹腔镜手术后碳酸利多卡因盆腔冲洗和创口局部浸润联合静脉氟比洛芬酯较单独应用明显减轻了患者术后疼痛程度,减少了术后镇痛药的使用,且没有增加恶心呕吐的发生率.Objective To compare the analgesia effect of mono or combination of intrapelvic irrigation and incision infiltration with lidocaine carbonate and intravenous flurbiprofen axetil after gynecological laparoscopy.Methods Sixty patients scheduled for gynecological laparoscopy under general anesthesia were randomized to three groups using the method of random number table.Patients in group F received intravenous flurbiprofen axetil 100 mg after surgery; patients in group L received intrapelvic irrigation and abdominal wounds infiltration with 0.35％ lidocaine carbonate 100 ml and 0.87 ％ lidocaine carbonate 10 ml respectively; patients in group FL received the combination of group F and group L.Pain was controlled with sufentanil 5 μg in PACU and tramadol 100 mg in ward.Repeated injection was permitted when necessary,VAS pain scores were measured at 1,4,8,12 and 24 h after operation.Total analgesic requirement,the first passage of flatus and incidence of nausea and vomiting within 24 hours were recorded as well as side effects such as circumoral numbness,dizziness,and tinnitus.Results VAS scores in group FL were significantly lower than those in group F and group L at 1 24 h after surgery （P＜0.05）.There was less pain in group L than that in the group F at 1 h after surgery（P＜0.05）.Four in group F and five in group L received sufentanil.One in group F received tramadol.No patient in group FL needed analgesia.No patient required repeated analgesia in the three groups.Conclusion Combination of intravenous flurbiprofen axetil and intrapelvic irrigation （including wound infiltration） with lidocaine carbonate can significantly reduce the pain intensity and analgesia requirement without increasing the incidence of nausea and vomiting compared with intravenous flurbiprofen axetil or intrapelvic irrigation alone after gynecological laparoscopy.

关 键 词：利多卡因 氟比洛芬酯 术中镇痛 腹腔镜手术 

分 类 号：R614[医药卫生—麻醉学]