布比卡因阻滞对腹腔镜胆囊切除术后超前镇痛的比较研究  

Bupivacaine preemptive analgesia in laparoscopic cholecystectomy: A controlled study

作　　者：程明华[1] 杨普春[1] 许映娜[1] 郑淦基[1] 

机构地区：[1]汕头大学医学院第一附属医院麻醉科,汕头515041

出　　处：《中国微创外科杂志》2004年第1期47-49,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的　探讨躯体 -内脏神经阻滞对腹腔镜胆囊切除术后超前镇痛效果。　方法　病人随机分为 4组 ,每组 2 5例 ,A组 (躯体阻滞组 )在切皮前以 0 2 5 %布比卡因 2 5ml(含 1∶2 0 0 0 0 0肾上腺素 )进行切口周围浸润 ;B组 (内脏阻滞组 )在气腹后立即以 0 2 5 %布比卡因 35ml腹腔内喷洒 ;C组 (躯体 -内脏联合阻滞组 )进行A组和B组综合处理 ;D组 (对照组 )不予处理。在术后 1、2、3、6、12、2 4、4 8h分别评估疼痛强度、部位和恶心情况。　结果　术后 12h内 ,D组切口痛明显强于其它部位疼痛 (P <0 0 5 )。A、C组在术后 6h内疼痛强度和镇痛药物需求量比B、D组明显减少 (P <0 0 5 )。　结论　腹腔镜胆囊切除术后疼痛以切口痛为主 ,术前躯体 -内脏神经阻滞处理能明显减轻术后早期切口痛 ,但对腹内痛、肩部痛的镇痛效果并不比单用躯体阻滞更好。术前布比卡因切口躯体神经阻滞值得推荐。Objective To investigate the preemptive analgesic effects of somato-visceral blockade in laparoscopic cholecystectomy (LC). Methods One hundred patients were randomly divided into four groups: Group A received peri-portal infiltration of 25 ml 0.25% bupivacaine (contained 1:200 000 epinephrine) before incision; Group B received intraperitoneal spray of 35ml 0.25% bupivacaine immediately after the establishment of pneumoperitoneum; Group C received the management of both Group A and Group B; Group D was control group without management. The extent and location of pain and nausea were recorded and assessed at 1, 2, 3, 6, 12, 24 and 48 postoperative hours, respectively. Results In the control group the incisional pain dominated over other pain locations within 24 hours postoperatively (P<0.05). The extent of pain and the analgesic requirement in Group A and C within the first 6 postoperative hours were significantly lower than those in other groups (P<0.05). Conclusions Incisional pain dominates over the period following LC. Preoprative somato-visceral blockade anesthesia can remarkably relieve the postoperative early incisional pain, but is not better than somatic blockade alone for intra-abdominal pain and shoulder pain. The preoperative incisional blockade of bupivacaine is recommended.

关 键 词：腹腔镜胆囊切除术 超前镇痛 布比卡因 

分 类 号：R614[医药卫生—麻醉学]