【摘要】 目的 评估罗哌卡因切口预注射联合曲马多对腹腔镜下胆囊切除术（laparoscopic cholecystectomy，LC）术后疼痛的影响。 方法 选取2010年6月-2011年4月行择期LC患者120例，年龄18~65岁，美国麻醉师协会Ⅰ~Ⅱ级，采用完全随机的设计分组：0.75%罗哌卡因10 mL切口注射+术毕静脉注射曲马多（2 mg/kg）组（A组，n=30）；生理盐水10 mL切口注射+术毕静脉注射曲马多（2 mg/kg）组（B组，n=30）；0.75%罗哌卡因10 mL切口注射+术毕静脉注射生理盐水10 mL组（C组，n=30）；生理盐水组（D组，n=30）。术后2、4、6、12、24 h分别评估右上腹部、右肩背部和腹壁切口疼痛进行视觉模拟评分（visual analog scale，VAS）。 结果 右上腹部及右肩背部疼痛VAS比较：与D组相比，A、B组VAS评分明显减少（Plt;0.05），而C组无明显统计学差异（Pgt;0.05）；B组与A组相比，2~24 h VAS评分明显增加（Plt;0.05）；C组与A组相比，2~24 h VAS评分增高（Plt;0.01）。腹壁切口疼痛VAS比较:与D组相比，A、B、C组VAS评分明显减少（Plt;0.05）；B组与A组相比，2~24 h VAS评分明显增加（Plt;0.05）；C组与A组相比，2~24 h VAS评分显著增高（Plt;0.01）。 结论 腹腔镜胆囊切除术术前切口罗哌卡因预注射-术毕曲马多静脉注射对减轻术后疼痛有良好效果。【Abstract】 Objective To evaluate the effects of preincisional ropivacaine plus tramadol intravenous injection on postoperative pain relief after laparoscopic cholecystectomy (LC). Methods One hundred and twenty patients aged between 18 and 65 years old with an ASA score from Ⅰ to Ⅱ who underwent elective laparoscopic cholecystectomy from June 2010 to April 2011 comprised this study. The patients were randomly divided into four groups with 30 in each group. Patients in group A had an infusion of 0.75% ropivacaine (10 mL) at the beginning of LC plus tramadol (2 mg/kg) intravenous injection at the end. Group B patients had an infusion of normal saline 0.9% (10 mL) at the beginning of LC plus tramadol (2 mg/kg) intravenous injection at the end. Patients in group C had an infusion of 0.75% ropivacaine (10 mL) at the beginning of LC plus normal saline 0.9% (10 mL) intravenous injection at the end. Group D (control group) patients had neither ropivacaine nor tramadol infusion. Pain in the right upper abdomen, right shoulder tip and abdominal incision were assessed at hour 2, 4, 6, 12, and 24 postoperatively using a visual analog score (VAS). Results Right upper abdomen and right shoulder tip pain VAS comparison: significantly lower pain scores were observed in group A and B (Plt;0.05) than in group D (Pgt;0.05). Group A had significantly lower pain scores than group B (Plt;0.05) and C (Plt;0.01) at postoperative hours 2, 4, 6, 12, and 24. Abdominal incision pain VAS comparison: VAS scores were significantly lower in group A, B and C than in group D (Plt;0.05). Group A had significantly lower pain scores than group B (Plt;0.05) and C (Plt;0.01) at postoperative hours 2, 4, 6, 12, and 24. Conclusion Preincisional ropivacaine at the beginning of LC combined with tramadol intravenous injection at the end can effectively alleviate postoperative pain after laparoscopic cholecystectomy.
目的 探讨盐酸氨基葡萄糖胶囊联合透明质酸钠注射液治疗髋骨关节炎的临床疗效。 方法 纳入疼痛门诊2010年7月－2011年7月收治的髋骨关节炎患者60例，随机分为透明质酸钠关节腔内注射联合口服盐酸氨基葡萄糖胶囊组（A组）和单独透明质酸钠关节腔内注射组（B组），每组30例。透明质酸钠关节腔内注射均为2.5 mL/次，每周1次，连续5周为1疗程。盐酸氨基葡萄糖胶囊口服，0.75 g/次，2次/d，6周为1个疗程。评估两组患者治疗后6周后髋关节疼痛视觉模拟评分（VAS评分）及Lequesne指数评定髋关节休息痛、运动痛、局部压痛、关节活动度、晨僵及行走能力，并观察两组不良反应发生情况。 结果 治疗6周后A组Lequesne功能指数及VAS评分较B组显著降低（P＜0.05），两组不良反应比较差异无统计学意义（P＞0.05）。 结论 治疗髋骨关节炎患者时，联合应用透明质酸钠及盐酸氨基葡萄糖胶囊疗效优于单独应用透明质酸钠者，且并未增加不良反应的发生。
Objective To investigate whether the peri pheral administration of amitri ptyl ine and bupivacaine produces anti-hyperalgesic effect and to screen the neurotoxicological effect on sciatic nerve blockade in a rat model of neuropathic pain. Methods Twenty-four adult male SD rats [weighing (200 ± 20) g] were made the models of chronic constriction injury (CCI) and randomly divided into 3 groups (n=8) 5 days after operation: group A (amitriptyl ine), group B (bupivacaine) and group C (normal sal ine). 0.5 mL 0.5% amitriptyl ine, 0.5% bupivacaine or normal sal ine were given in group A, group B, and group C, respectively through implanted cannulas after 5, 7 and 9 days of CCI once a day for successive 3 days. The motor function was measured before administration and 1, 2, 4, 8, 12 and 24 hours after every administration. Mechanical withdrawal threshold (MWT) and thermal withdrawal latency (TWL) were measured before administration and 1, 3, 5 and 7 days after the third administration. The operated sciatic nerve samples were obtained for neuropathological examination under l ight microscope. Results Twenty-four CCI rats were all survival without infection, palsy and catheter fall ing off. Compared with group C, the rats of group A and group B both produced significant ambulation deficits after every administration (P lt; 0.05). The ambulation deficits lasted 2 hours (group B) and 8 hours (group A) respectively. But the ambulation deficits of CCI rats were all reversible. The MWT and TWL of group A 1 and 3 days after the third administration increased when compared with those before administration and 5 and 7 days after the third administration, and when compared with group B and group C (P lt; 0.05). There was no significant difference (P gt; 0.05) in l ight microscopic neuropathological examination among three groups. Epineurial tissue and endoneurium tissue integrity, tidy arrangement of fibers, less inflammatory cell and no marked degeneration of myel inated fibers were observed. Conclusion Repeated sciatic nerve blockade with 0.5% amitriptyl ine has peripheral anti-hyperalgesic effects on neuropathic pain of rats. No morphological evidence of neurotoxicity in the sciatic nerve of rats is observed in 0.5% amitriptyl ine.