罗哌卡因复合小剂量右美托咪定TAP阻滞预防妇科腹腔镜手术后疼痛的临床观察(1)
[摘要] 目的 观察罗哌卡因复合小剂量右美托咪定超声引导下腹横肌平面阻滞(TAP)在预防预防妇科腹腔镜手术后疼痛的效果。 方法 选择行妇科腹腔镜宫外孕手术80例，分为观察组和对照组，各40例，两组患者均行气管插管全身麻醉，观察组在麻醉后超声引导下行双侧腹横肌平面阻滞，各注入0.4%罗哌卡因复合0.5μg/kg的右美托咪定药液15mL，术毕患者视觉模拟评分(VAS)评分>5分侧静注曲马多1.5mg/kg。记录两组患者拔管后(T0)、10min(T1)、20min(T2)、30min(T3)、40min(T4)的疼痛VAS评分、舒适程度评分(BCS)以及并发症发生率和使用曲马多的患者例数。 结果 观察组患者在T0 ～ T4各时点的疼痛 VAS 评分和BCS舒适程度评分明显低于对照组，差异有统计学意义(P<0.01)，并发症发生率和术后使用曲马多的例数明显少于对照组，差异有统计学意义(P<0.01)。 结论 罗哌卡因复合小剂量右美托咪定超声引导下腹横肌平面阻滞可有效预防妇科腹腔镜手术后的急性疼痛。
[关键词] 右美托咪定；腹横肌平面阻滞；疼痛；手术后
[中图分类号] R726.1 [文献标识码] A [文章编号] 2095-0616(2017)13-121-04
[Abstract] Objective To observe effect of transversus abdominis plane block under ultrasonic guidance of ropivacaine combined with small-dose dexmedetomidine in prevention of pain after gynecologic laparoscopic surgery. Methods 80 patients with ectopic pregnancy who underwent gynecologic laparoscopic surgery were selected and they were divided into the observation group and the control group，with 40 in each.Patients in two groups were all given general anesthesia with endotracheal intubation.The observation group was given bilateral transversus abdominis plane block under ultrasonic guidance after anesthesia.They were all respectively injected 0.4% ropivacaine combined with 0.5 μg/kg dexmedetomidine of 15mL.After surgery，patients with visual analogue scale (VAS) score >5 were given 1.5mg/kg tramadol by intravenous injection.Pain VAS score， body comfort scale (BCS)，complication rate and number of patients who were given tramadol at (T0)，10min (T1)，20min (T2) ，30min (T3) and 40min(T4) after extubation of patients in two groups were recorded. Results Pain VAS score and BCS score at (T0)，10min(T1)，20min(T2)，30min(T3) and 40min(T4)of patients in the observation group were both significantly lower than those of the control group.The difference was significant (P<0.01).Complication rate and number of patients who were given tramadol after surgery in the observation group were both significantly fewer than those of the control group.The difference was significant (P<0.01). Conclusion Transversus abdominis plane block under ultrasonic guidance of ropivacaine combined with small-dose dexmedetomidine can effectively prevent acute pain after gynecologic laparoscopic surgery.
[Key words] Dexmedetomidine；Transversus abdominis plane block；Pain；After surgery
婦科腹腔镜宫外孕手术具有创伤小、手术时间短、患者年轻和恢复快的特点，因而要求麻醉使用效果好、代谢快的麻醉药，瑞芬太尼是一种超短效阿片μ受体激动剂，具有起效迅速，镇痛效果好，消除快，长时间大剂量使用体内无蓄积等特点，特别适合在腹腔镜宫外孕手术麻醉中使用，但是瑞芬太尼停止用药后发生阿片类药物耐受以及痛觉过敏，痛觉过敏的发生率高达16.1%[1]，使用帕瑞昔布钠、曲马多、布托啡诺、地佐辛、舒芬太尼等可以预防瑞芬太尼麻醉后所急性疼痛[2-5]，但这些镇痛药会对患者产生不良反应，本文使用罗哌卡因复合小剂量右美托咪定超声引导下腹横肌平面阻滞(TAP)预防妇科腹腔镜手术后急性疼痛进行了临床观察，现报道如下。, 百拇医药(黄坚 唐波 麦伟良)
[关键词] 右美托咪定；腹横肌平面阻滞；疼痛；手术后
[中图分类号] R726.1 [文献标识码] A [文章编号] 2095-0616(2017)13-121-04
[Abstract] Objective To observe effect of transversus abdominis plane block under ultrasonic guidance of ropivacaine combined with small-dose dexmedetomidine in prevention of pain after gynecologic laparoscopic surgery. Methods 80 patients with ectopic pregnancy who underwent gynecologic laparoscopic surgery were selected and they were divided into the observation group and the control group，with 40 in each.Patients in two groups were all given general anesthesia with endotracheal intubation.The observation group was given bilateral transversus abdominis plane block under ultrasonic guidance after anesthesia.They were all respectively injected 0.4% ropivacaine combined with 0.5 μg/kg dexmedetomidine of 15mL.After surgery，patients with visual analogue scale (VAS) score >5 were given 1.5mg/kg tramadol by intravenous injection.Pain VAS score， body comfort scale (BCS)，complication rate and number of patients who were given tramadol at (T0)，10min (T1)，20min (T2) ，30min (T3) and 40min(T4) after extubation of patients in two groups were recorded. Results Pain VAS score and BCS score at (T0)，10min(T1)，20min(T2)，30min(T3) and 40min(T4)of patients in the observation group were both significantly lower than those of the control group.The difference was significant (P<0.01).Complication rate and number of patients who were given tramadol after surgery in the observation group were both significantly fewer than those of the control group.The difference was significant (P<0.01). Conclusion Transversus abdominis plane block under ultrasonic guidance of ropivacaine combined with small-dose dexmedetomidine can effectively prevent acute pain after gynecologic laparoscopic surgery.
[Key words] Dexmedetomidine；Transversus abdominis plane block；Pain；After surgery
婦科腹腔镜宫外孕手术具有创伤小、手术时间短、患者年轻和恢复快的特点，因而要求麻醉使用效果好、代谢快的麻醉药，瑞芬太尼是一种超短效阿片μ受体激动剂，具有起效迅速，镇痛效果好，消除快，长时间大剂量使用体内无蓄积等特点，特别适合在腹腔镜宫外孕手术麻醉中使用，但是瑞芬太尼停止用药后发生阿片类药物耐受以及痛觉过敏，痛觉过敏的发生率高达16.1%[1]，使用帕瑞昔布钠、曲马多、布托啡诺、地佐辛、舒芬太尼等可以预防瑞芬太尼麻醉后所急性疼痛[2-5]，但这些镇痛药会对患者产生不良反应，本文使用罗哌卡因复合小剂量右美托咪定超声引导下腹横肌平面阻滞(TAP)预防妇科腹腔镜手术后急性疼痛进行了临床观察，现报道如下。, 百拇医药(黄坚 唐波 麦伟良)