术前应用帕瑞昔布钠复合局部浸润麻醉对腹腔镜手术后镇痛的影响  

The effect of analgesia with intravenous parecoxib combined with local infiltration anesthesia before laparoscopic surgery

作　　者：孙晓群[1] 倪加华 徐红娟[1] 王超[1] 孙志强[1] 朱瑾[1] 

机构地区：[1]江苏省扬中市人民医院麻醉科,212200

出　　处：《临床麻醉学杂志》2014年第10期1005-1007,共3页Journal of Clinical Anesthesiology

基　　金：2013年度镇江市科技支撑计划指导性项目(FZ201312)

摘　　要：目的探讨术前应用帕瑞昔布钠复合0.5%左旋布比卡因局部浸润麻醉对腹腔镜手术后镇痛的影响。方法择期腹腔镜手术患者66例,随机分为两组,帕瑞昔布钠复合0.5%左旋布比卡因局部浸润麻醉组(P组)和生理盐水(C组);观察苏醒拔管后、术后1、2、4、6、12、24h疼痛数字(NRS)评分和舒适(BCS)评分,如NRS评分大于4分静脉给予地佐辛5mg/次,直至评分小于3分,记录术后24h内地佐辛、首次补救镇痛药的时间和满意率,以及恶心、呕吐、呼吸抑制不良反应。结果最终P组32例,C组31例患者纳入分析。与C组比较,术后4、6、12和24hP组NRS评分明显降低、BCS评分明显升高(P<0.05)。与C组比较,术后24h内P组地佐辛用量明显减少、首次补救镇痛药时间明显延长、满意率明显提高(P<0.01)。两组术后恶心、呕吐和呼吸抑制发生率差异无统计学意义。结论腹腔镜手术前应用帕瑞昔布钠复合0.5%左旋布比卡因局部浸润麻醉能有效抑制患者术后疼痛,提高患者术后满意度,且降低不良反应的发生率,安全性高,是该类手术术后疼痛干预有效的方法。Objective To investigate the effect of analgesia with parecoxib combined 0.5%levobupivacaine local infiltration anesthesia before laparoscopic surgery.Methods Sixty-six laparoscopic surgical patients were randomly divided into group P or group C.Group P patients received parecoxib combined with 0.5%levobupivacaine local infiltration anesthesia.Group C patients received the same volume of saline.Numeric rating scale（NRS）and Bruggrmann comfort scale（BCS）after extubation,1,2,4,6,12,24 hpostoperatively were recorded.Additional dezocine was administered when NRS score greater than 4until the score less than 3.Total amount of analgesic drugs 24 hpostoperatively,the time when patients started to receive analgesic drug,the incidence of nausea and vomiting,respiratory depression were also compared.Results NRS 4,6,12,24 hafter surgery were significantly lower but BCS were higher in group P than those in group C（P〈0.05）.Dezocine dosage was significantly less in group P than group C 24 hafter surgery（P〈0.01）.The time when patients started to receive analgesic drug was significantly delayed with more satisfaction in group P than group C.There was no significant difference in adverse reaction between the two groups.Conclusion Parecoxib combined with0.5%levobupivacaine infiltration anesthesia in laparoscopic surgery can significantly reduce postoperative pain,increase patients satisfaction without increasing adverse effect.

关 键 词：腹腔镜手术 术后镇痛 帕瑞昔布钠 左旋布比卡因 浸润麻醉 

分 类 号：R614[医药卫生—麻醉学]