摘要
目的:评估宫-腹腔镜检查患者术前应用帕瑞昔布钠并联合应用切口周围注射罗哌卡因对术后肩痛和切口疼痛的影响。方法:60例择期全身麻醉下行宫-腹腔镜检查的患者随机分为两组,一组患者(组1,n=30)麻醉诱导前静脉注射帕瑞昔布钠40 mg(生理盐水2 mL稀释),建立气腹前切口注射0.5%(体积分数)罗哌卡因20 mL;另一组患者(组2,n=30)麻醉诱导前静脉注射生理盐水2 mL,建立气腹前切口注射0.5%罗哌卡因20 mL。术后记录停药后患者的苏醒时间和睁眼时间,患者在恢复室内(0 h)和术后2 h、4 h、8 h、12 h、24 h、48 h的切口疼痛和肩痛的评分,以及术后患者应用曲马多的次数和剂量。结果:与组2患者相比,组1患者的术后肩痛发生率较低(37%vs.67%,P=0.020),术后48 h内重度疼痛的发生患者较少(4 vs.11,P=0.037);术后12 h,组1患者的右侧肩痛数字评分法(numerical rating scales,NRS)评分为0(0,2),而组2患者为0(0,8),两组差异有统计学意义(P=0.012);组1患者的左侧肩痛的NRS评分在术后12 h和24 h分别为0(0,1)和0(0,4),也低于组2患者的0(0,8)和2(0,9),差异有统计学意义(P=0.026,P=0.014)。术后即刻,组1患者腹部切口疼痛的动态和静态NRS评分均低于组2患者(P=0.001,P=0.005);术后12 h和24 h,组1患者的腹部切口疼痛的静态NRS评分也低于组2患者(P=0.042,P=0.029)。组2患者术后24 h内需应用曲马多的例数多于组1(8 vs.0,P=0.002)。结论:术前应用帕瑞昔布钠并切口周围注射罗哌卡因可显著改善宫-腹腔镜检查术后的肩痛和切口疼痛。
To evaluate the combined effect of premedication of parecoxib sodium and local infiltration of ropivocaine on postoperative shoulder pain and incisional pain in patients undergoing diagnostic hysteroscopy and laparoscopy. Methods： In the study, 60 patients undergoing elective diagnostic hysteroscopy and laparoscopy were randomly allocated to two groups （each with 30 patients）. The patients in group 1 were premedicated with 40 mg parecoxib sodium （diluted with 2 mL normal saline）, and 0.5% ropivacaine （20 mL） were infiltrated around the incision site before establishment of CO2 pneumoperitoneum. The patients in group 2 received 2 mL normal saline intraveniously before anesthesia induction, and infiltration of 0.5% ropivacaine 20 mL were also applied as group 1. After anesthetic withdrawal, the patients’ postoperative anesthesia recovery time and the time point of opening eyes on verbal command were noted. The intensities of postoperative shoulder pain and incisional pain were evaluated at 0, 2, 4, 8, 12, 24, and 48 h after surgery. The postoperative analgesic requirement was met by administration of tramadol. Results： Compared with group 2, the incidence of postoperative shoulder pain was less in group 1 （37% vs. 67%, P=0.020）, and the occurence of severe pain was lower （4 vs. 11, P=0.037）. The numerical rating scales （NRS） of right shoulder pain of group 1 were significantly reduced than those of group 2 at 12 h postoperatively [0 （0, 2） vs. 0 （0, 8）, P=0.012]. Left shoulder pain did not appear at 0 h and 2 h in both groups, while at 12 h and 24 h postoperatively, the NRS scores of group 1 were lower than those of group 2 [0 （0, 1） vs. 0 （0, 8）, P=0.026; 0 （0, 4） vs. 2 （0, 9）, P=0.014]. The dynamic and static abdominal pain scores of group 1 were significantly decreased than those of group 2 in postanesthesia care unit （PACU） after surgery （P=0.001, P=0.005）. The NRS scores of static abdominal pain of group 1 were significantly reduced than those of group 2 at 12 h and 24 h postoperatively （P=0.042, P=0.029）. More patients in group 2 needed tramadol within 24 h postoperatively （8 vs. 0, P=0.002）. Conclusion： Premedication of parecoxib sodium combined with local infiltration of ropinvocaine before incision could significantly reduce the postoperative shoulder pain and incisional pain as well as reduce opioid consumption in patients undergoing diagnostic hysteroscopy and laparoscopy.
出处
《北京大学学报（医学版）》
CAS
CSCD
北大核心
2013年第6期901-905,共5页
Journal of Peking University:Health Sciences
