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局部麻醉药在腹腔镜中胆囊切除术的应用

摘要:目的:探讨通过腹腔内注射局部麻醉药在腹腔镜胆囊切除术中的镇痛效果。方法:52例患者随机分为4组,Ⅰ组术前腹腔内喷洒0.75％罗哌卡因20 mL;Ⅱ组术后腹腔内喷洒0.75％罗哌卡因20 mL;Ⅲ组为术后腹腔内喷洒0.5％布比卡因20 mL;Ⅳ组术后腹腔内喷洒生理盐水20 mL。麻醉方法均为全凭静脉麻醉。术后1、2、3、4 h 4个时间点记录患者术后疼痛视觉模拟评分(VAS)。并观察4组术后使用镇痛药物的例数和肩背痛、恶心呕吐发生率。结果:术后1、2、3、4 h VAS评分Ⅱ组lt;Ⅲ组lt;Ⅰ组lt;Ⅳ组(Plt;0.05)。Ⅳ组使用镇痛药物的例数明显高于Ⅰ组、Ⅱ组和Ⅲ组(Plt;0.05)。4组术后肩背痛、恶心呕吐发生率差异无显著性(Pgt;0.05)。结论:经腹腔给局麻药镇痛效果明显,术毕给药镇痛效果优于术前给药,罗哌卡因镇痛效果优于布比卡因。Abstract: Objective: To investigate the effect of intraperitoneal local anesthetic on patients undergone laparoscopiccho1ecystectomy.Methods:Fiftytwo patients were randomly divided into four groups. Group Ⅰ received preoperational anesthetic spary with 20 mL of 0.75％ ropivacaine. Group Ⅱ was given the anesthetic ata same dosage after the operation. Group Ⅲ received preoperational anesthetic spary with 20 mL of 0.5％ bupivacaine. Group Ⅳ received preoperational anesthetic spary with 20 mL saline. The LC was completed under general anesthesia.After the operation,visual analog scale (VAS)was recorded at 1,2,3 and 4 hours to evaluate the degree of postoperative pain.Meanwhile,the number of the patients who received anesthetics after the surgery,as well as the incidence rates shoulder or back pain and nausea or vomiting were recorded. Results: Postoperative VAS of the group Ⅱ was significantly lower than that of the other three groups, while the VAS of group Ⅲ was significantly lower than that in group Ⅰ(both Plt;0.05).Compared to groups Ⅰ, Ⅱ and Ⅲ,more patients in the group Ⅳ needed anesthetics after the operation (Plt;0.05).No significant diference was noticed in the incidence rates of shoulder or back pain and nausea or vomiting among the four groups (Pgt;0.05).Conclusions: Intraperitoneal local anesthetic can significantly reduce postoperative pain after LC. It is more effective to give local anesthetic at the end of the procedure than using it before operation. The effect of ropivacaine is better than bupivacaine.