局部浸润麻醉应用于拇外翻术后镇痛的可行性研究  

Feasibility study on local infiltration anesthesia for postoperative analgesia in patients with hallux valgus

作　　者：孔德海[1] 赵永杰 关国锋 邓明明 尹刚[1] 孙广超[1] KONG De-hai;ZHAO Yong-jie;GUAN Guo-feng;DENG Ming-ming;YIN Gang;SUN Guang-chao(Binzhou Medical University Hospital,Binzhou 256600,Shandong,China)

机构地区：[1]滨州医学院附属医院,山东滨州256600

出　　处：《中国骨伤》2021年第12期1182-1185,共4页China Journal of Orthopaedics and Traumatology

摘　　要：目的:探讨罗哌卡因联合复方倍他米松局部浸润麻醉在拇外翻术后镇痛中的临床疗效及不良反应。方法:自2019年9月至2020年12月手术治疗拇外翻患者48例,根据术后不同镇痛方式分为联合局部浸润组和静脉镇痛泵组。联合局部浸润组24例,男2例,女22例;年龄21~78 (58.3±7.7)岁;行软组织松解加Chevron截骨15例,行跖趾关节融合9例;术后即刻应用罗哌卡因联合复方倍他米松混合稀释液20 ml局部浸润麻醉1次。镇痛静脉镇痛泵组24例,男3例,女21例;年龄23~81 (56.8±8.3)岁;行软组织松解加Chevron截骨17例,跖趾关节融合7例;术后即刻静脉镇痛泵进行镇痛,设置基础流量为2 ml/h,自控剂量为0.5 ml,锁定时间15 min。记录患者术后12、24、48、72 h疼痛视觉模拟评分(visual analogue scale,VAS),同时记录术后24 h换药时VAS,记录术后0~12 h、12~24 h、24~48 h药品不良反应发生情况,并记录拆线后刀口愈合情况。结果:所有患者获得随访,时间14~17(14.60±0.92) d。术后联合局部浸润组与静脉镇痛泵组12、24、48 h VAS比较差异有统计学意义(P<0.05)。术后两组72 h VAS比较差异无统计学意义(P>0.05)。两组术后0~12 h发生药品不良反应例数比较差异无统计学意义(P>0.05);术后12~24 h发生药品不良反应例数比较差异有统计学意义(P<0.05);术后24~48 h两组均未发生麻醉药品不良反应。拆线后两组刀口愈合等级比较差异无统计学意义(P>0.05)。结论:与静脉镇痛泵镇痛相比,罗哌卡因联合复方倍他米松的局部浸润麻醉在不增加麻醉药品不良反应的情况下,可显著降低患者拇外翻术后伤口疼痛,且不增加刀口感染风险。Objective:To evaluate the clinical efficacy of local infiltration anesthesia of ropivacaine combined with compound betamethasone for postoperative analgesia in patients with hallux valgus.Methods:From September 2019 to December2020,48 patients with hallux valgus were treated surgically.According to different postoperative analgesia methods,the patients were divided into combined local infiltration group and intravenous analgesia pump group.There were 24 cases,in the combined local infiltration group including 2 males and 22 females;the age ranged from 21 to 78 years old,with an average of(58.3±7.7) years old;soft tissue release and chevron osteotomy were performed in 15 cases and metatarsophalangeal joint fusion in 9 cases;immediately after operation,20 ml of ropivacaine combined with compound betamethasone mixed diluent was used for local infiltration anesthesia once.There were 24 patients in intravenous analgesia pump group including 3 males and21 females;the age ranged from 23 to 81 years old,with an average of(56.8±8.3) years old;soft tissue release and Chevron osteotomy were performed in 17 cases and metatarsophalangeal joint fusion in 7 cases;immediately after operation,intravenous analgesia pump was used for analgesia.The basic flow was 2 ml/h;the self-control dose was 0.5 ml;and the locking time was15 min.Visual analogue scale(VAS) was recorded at 12,24,48 and 72 hours after operation;and the VAS was recorded at 24 hours after operation.The occurrence of adverse drug reactions at 0 to 12 hours,12 to 24 hours and 24 to 48 hours after operation were recorded;and the healing of incision was recorded.Results:All patients were followed up,and the duration ranged from 14 to 17 days,with a mean of(14.60±0.92) days.There was significant difference in VAS at 12,24 and 48 hours between the combined local infiltration group and the intravenous analgesia pump group(P<0.05).There was no significant difference in VAS between the two groups 72 hours after operation(P>0.05).There was no significant difference in the n

关 键 词：拇外翻 倍他米松 麻醉 局部 

分 类 号：R687.1[医药卫生—骨科学]