罗哌卡因局部浸润缓解经皮肾镜取石术后疼痛的前瞻性研究  

Alleviating postoperative pain in patients with percutaneous nephrolithotomy by using local anesthetic infiltration of ropivacaine

作　　者：蔡锦全[1] 陈书尚[1] 朱凌峰[1] 吴承耀[1] 邓震[1] 谭建明[1] 

机构地区：[1]南京军区福州总医院泌尿外科,福建福州350025

出　　处：《东南国防医药》2015年第4期365-367,共3页Military Medical Journal of Southeast China

摘　　要：目的探讨经皮肾穿刺通道周围局部浸润罗哌卡因缓解经皮肾镜取石(percutaneous nephrolithotomy,PCNL)术后疼痛的效果。方法对接受单通道PCNL治疗的上尿路结石患者60例,随机分为两组,观察组和对照组(各30例)。观察组于PCNL术中留置肾造瘘管后,于经皮肾穿刺通道周围注射0.5%罗哌卡因20 m L,对照组则于相同部位注射等渗盐水20m L。比较两组患者术后1、3、6、12、24 h的疼痛评分(VAS),术后哌替啶使用情况及并发症。结果与对照组相比,观察组患者术后24 h内各相应时点的平均VAS评分均明显降低(P<0.05),哌替啶用量明显减少[(21.7±13.5)mg vs(39.8±29.4)mg,P<0.05],首次需要应用哌替啶的时间明显延长[(16.6±9.7)h vs(6.8±4.2)h,P<0.01],而恶心及呕吐的发生率明显减少(23.3%vs 40.0%,P<0.05)。结论罗哌卡因经皮肾穿刺通道周围局部浸润可有效缓解PCNL术后的切口疼痛,减少术后镇痛药需要量和相应并发症。Objective To explore the analgesic efficacy of peritubal local anesthetic infiltration of ropivacaine in alleviating postoperative pain in patients with percutaneous nephrolithotomy （ PCNL） .Methods A total of 60 patients with upper urinary calculi were included and randomized into the ropivacaine group and the control group （ both 30 cases） .The patients in the ropivacaine group received a 20 mL infiltration of 0.5%ropivacaine into the Peritubal sites after a nephrostomy tube was inserted during PCNL, while pa-tients in the control group received 20 mL infiltration of saline.After the operation, patients＆#39;visual analog scale （ VAS） pain scores at 1, 3, 6, 12 and 24 hours, the usage of pain relief drugs and complications in the two groups were recorded.Results Compared with the control group, significant lower VAS pain scores at 1, 3, 6, 12, and 24 hours postoperatively （P〈0.05 for all）, less mean a-mount of pethidine [（21.7 ±13.5）mg vs （39.8 ±29.4）mg,P〈0.05], longer mean time for the first demand of pethidine [（16.6 ± 9.7） h vs （6.8 ±4.2） h,P〈0.01], and a lower rate of nausea and/or emesia （23.3%vs 40.0%, P〈0.05） were observed in the experiment group.Conclusion Peritubal local anesthetic infiltration of ropivacaine can effectively alleviate postoperative pain after PCNL, and can reduce the usage of postoperative pain-killer as well as the related complications.

关 键 词：罗哌卡因 经皮肾镜取石术 造瘘管 疼痛 

分 类 号：R692.4[医药卫生—泌尿科学]