地塞米松联合罗哌卡因在腹股沟疝修补术中的超前镇痛效果评估
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摘要
目的评估地塞米松加入罗哌卡因的腹横肌平面阻滞在腹股沟疝修补术后的镇痛效果。方法 2015年8月至2017年6月因腹股沟疝就诊且行开放式无张力疝修补术的100例成年男性患者,随机分成地塞米松辅助罗哌卡因组(D组)和罗哌卡因组(C组)。术前超声引导下行腹横肌平面阻滞,手术均由同一组外科医师完成,术后口服塞来昔布。记录术后48h内VAS评分、临床症状、塞来昔布的使用情况以及术后1周的卡洛连舒适度评分(carolinas comfort scale,CCS)情况。结果两组患者术后48h VAS评分比较,差异无统计学意义,术后空腹血糖、恶心呕吐症状,两组比较差异有统计学意义。术后72h塞来昔布使用情况,两组比较差异有统计学意义。术后CCS评分D组明显低于C组,差异有统计学意义。结论地塞米松辅助罗哌卡因TAP阻滞的超前镇痛并没有增加腹股沟疝修补术后镇痛强度,但减少了其他镇痛药物的使用时间和总剂量,且提高了术后患者舒适度。
Objective To evaluate the adjuvant analgesia effect of the addition of dexamethasone to ropiva-caine in a transversus abdominis plane(TAP)block after inguinal herniorrhaphy. Methods 100 adult male pa-tients who underwent open tension-free inguinal herniorrhaphy from August 2015 to June 2017,randomized intotwo groups equally. TAP block with ropivacaine with additional dexamethasone was experiment group(group D)and with ropivacaine was control group(group C). Before the operation,all the patients were performed TAP blockby the same group of surgeons. Celecoxib(200mg,Q12h,po)was prescribed to all patients in 48 hours after oper-ation. VAS and clinical symptoms were recorded. The sum and time of celecoxib consumption were also recorded af-ter 72 hours postoperatively. The surveys about the Carolinas comfort scale(CCS)of all the patients one week afteroperation were collected. Results The averaged pain score in 48 hours after operation has no statistical signifi-cance. The occurrence of postoperative nausea and vomiting of group D is lower than group C,neither of them werestatistically significant. The averaged CCS of group D was lower than group C;the difference was significant. Conclusions Compared to single usage of ropivacaine in the single-shot TAP as a preemptive analgesia method for in-guinal herniorrhaphy,adding dexamethasone to ropivacaine didn′t show significance in analgesic intensity after in-guinal herniorrhaphy,though the adjuvant usage of dexamethasone reduced the sum and duration of other analgesicmedications and enhanced the comfort of the patients after mesh-used herniorrhaphy.
Objective To evaluate the adjuvant analgesia effect of the addition of dexamethasone to ropiva-caine in a transversus abdominis plane(TAP)block after inguinal herniorrhaphy. Methods 100 adult male pa-tients who underwent open tension-free inguinal herniorrhaphy from August 2015 to June 2017,randomized intotwo groups equally. TAP block with ropivacaine with additional dexamethasone was experiment group(group D)and with ropivacaine was control group(group C). Before the operation,all the patients were performed TAP blockby the same group of surgeons. Celecoxib(200mg,Q12h,po)was prescribed to all patients in 48 hours after oper-ation. VAS and clinical symptoms were recorded. The sum and time of celecoxib consumption were also recorded af-ter 72 hours postoperatively. The surveys about the Carolinas comfort scale(CCS)of all the patients one week afteroperation were collected. Results The averaged pain score in 48 hours after operation has no statistical signifi-cance. The occurrence of postoperative nausea and vomiting of group D is lower than group C,neither of them werestatistically significant. The averaged CCS of group D was lower than group C;the difference was significant. Conclusions Compared to single usage of ropivacaine in the single-shot TAP as a preemptive analgesia method for in-guinal herniorrhaphy,adding dexamethasone to ropivacaine didn′t show significance in analgesic intensity after in-guinal herniorrhaphy,though the adjuvant usage of dexamethasone reduced the sum and duration of other analgesicmedications and enhanced the comfort of the patients after mesh-used herniorrhaphy.
引文
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[5]董盛龙,朱少飞,林赛娟,等.超声引导腹横肌平面阻滞对结肠癌开腹手术患者循环应激及术后镇痛的影响[J].实用医学杂志,2017,33(2):259-262.
[6]HAAPANEN A,THORéN H,T?RNWALL J,et al.Postopera-tive nausea and vomiting in facial fracture patients:A Random-ized and controlled trial on the effect of dexamethasone[J].Int JOral Maxillofacial Surg,2017,46(10):1267-1270.
[7]王英,刘立飞,王寿勇.超声引导下腹横肌平面阻滞在腹部术后镇痛中的应用研究进展[J].医学综述,2016,22(20):4072-4075.
[8]王有财,任莹坤,王松涛,等.经彩超引导下腹横肌平面阻滞技术联合罗哌卡因切口局部麻醉用于胃癌手术后的镇痛效果[J].实用医学杂志,2016,32(5):858-859.
[2]SCHNEPPER G D,KIGHTLINGER B I,JIANG Y,et al.A ret-rospective study evaluating the effect of low doses of perineuraldexamethasone on ropivacaine brachial plexus peripheral nerveblock analgesic duration[J].Pain Med,2017:1-9.
[3]周晓筠,吴靦,朱毅,等.不同麻醉方法对小儿腹腔镜手术应激反应和复苏质量的影响[J].实用医学杂志,2017,33(13):2186-2188.
[4]赵青川,刘小楠,丰帆,等.预防性镇痛在胃癌根治术中应用价值的前瞻性研究[J].中华消化外科杂志,2015,14(1):57-60.
[5]董盛龙,朱少飞,林赛娟,等.超声引导腹横肌平面阻滞对结肠癌开腹手术患者循环应激及术后镇痛的影响[J].实用医学杂志,2017,33(2):259-262.
[6]HAAPANEN A,THORéN H,T?RNWALL J,et al.Postopera-tive nausea and vomiting in facial fracture patients:A Random-ized and controlled trial on the effect of dexamethasone[J].Int JOral Maxillofacial Surg,2017,46(10):1267-1270.
[7]王英,刘立飞,王寿勇.超声引导下腹横肌平面阻滞在腹部术后镇痛中的应用研究进展[J].医学综述,2016,22(20):4072-4075.
[8]王有财,任莹坤,王松涛,等.经彩超引导下腹横肌平面阻滞技术联合罗哌卡因切口局部麻醉用于胃癌手术后的镇痛效果[J].实用医学杂志,2016,32(5):858-859.