甲哌卡因腹横筋膜阻滞对瑞芬太尼引起的痛觉超敏反应的影响
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摘要
目的观察甲哌卡因腹横筋膜阻滞对瑞芬太尼引起的痛觉超敏反应的影响。方法收集择期下行腹式全宫手术患者50例,分为甲哌卡因组(25例)和对照组(25例)。甲哌卡因组在麻醉诱导后在超声引导下用1.5%甲哌卡因行腹横筋膜阻滞,每侧20 mL,对照组不予腹横筋膜阻滞。麻醉维持均采用七氟烷0.8-1.1 MAC,瑞芬太尼0.05～0.3μg/kg·min,监测脑电双频指数(BIS),根据BIS值和血流动力学情况调整麻醉用药。观察并比较患者术中瑞芬太尼总的消耗量,术后1 h(VAS 1),3 h(VAS 2),6 h(VAS 3),12 h(VAS 4),24 h(VAS 5)的视觉模拟评分(VAS评分),术后病房镇痛药物的追加量及相关并发症。结果甲哌卡因组术中瑞芬太尼用量显著小于对照组(P<0.05),术后各时间点VAS评分小于对照组(均P<0.05),而术后镇痛药物追加次数小于对照组(P<0.05)。结论术前使用甲哌卡因腹横筋膜阻滞可明显减少术中瑞芬太尼用量,减轻瑞芬太尼引起的痛觉超敏反应。
Objective To investigate the effects of transversus abdominis plane block with mepivacaine on hyperalgesia,which was induced by remifentanil.Methods A total of 50 patients undergoing selective abdominal hysterectomy were randomly divided into mepivacaine group or control group.In mepivacaine group,1.5% mepivacaine 20 mL was used for transversus abdominis plane block under ultrasound guidance on each side after anesthesia induction,whereas no transversus abdominis plane block was performed in control group.The anesthesia was maintained with sevoflurane at 0.8-1.1 MAC and remifentanil at 0.05～0.3 μg/kg·min,which was adjusted depending on the hemodynamic changes and Bispectral index(BIS).The total intraoperative consumption of remifentanil,the degrees of postoperative pain using visual analogue score(VAS score)at 1 h(VAS 1),3 h(VAS2),6 h(VAS3),12 h(VAS4),and24 h(VAS 5)after surgery,as well as the frequency of analgesics supplement and related complications were observed and compared.Results The intraoperative consumption of remifentanil in mepivacaine group was significantly lower than that in control group(P<0.05),as well as the VAS score at each time point(P<0.05).And the frequency of postoperative analgesics supplementation was also less than that in control group(P<0.05).Conclusion Pretreatment of transversus abdominis plane block with mepivacaine can significantly reduce the consumption of intraoperative remifentanil,resulting in relieving hyperalgesia caused by remifentanil.
Objective To investigate the effects of transversus abdominis plane block with mepivacaine on hyperalgesia,which was induced by remifentanil.Methods A total of 50 patients undergoing selective abdominal hysterectomy were randomly divided into mepivacaine group or control group.In mepivacaine group,1.5% mepivacaine 20 mL was used for transversus abdominis plane block under ultrasound guidance on each side after anesthesia induction,whereas no transversus abdominis plane block was performed in control group.The anesthesia was maintained with sevoflurane at 0.8-1.1 MAC and remifentanil at 0.05～0.3 μg/kg·min,which was adjusted depending on the hemodynamic changes and Bispectral index(BIS).The total intraoperative consumption of remifentanil,the degrees of postoperative pain using visual analogue score(VAS score)at 1 h(VAS 1),3 h(VAS2),6 h(VAS3),12 h(VAS4),and24 h(VAS 5)after surgery,as well as the frequency of analgesics supplement and related complications were observed and compared.Results The intraoperative consumption of remifentanil in mepivacaine group was significantly lower than that in control group(P<0.05),as well as the VAS score at each time point(P<0.05).And the frequency of postoperative analgesics supplementation was also less than that in control group(P<0.05).Conclusion Pretreatment of transversus abdominis plane block with mepivacaine can significantly reduce the consumption of intraoperative remifentanil,resulting in relieving hyperalgesia caused by remifentanil.
引文
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[10]Liguori GA,Zayas VM.Repeated episodes of transient radiating back and leg pain following spinal anesthesia with 1.5%mepivacaine and 2%lidocaine[J].Reg Anesth Pain Med,1998,23(5):511-515.
[11]Pawlowski J,Orr K,Kim K,et al.Anesthetic and recovery profiles of lidocaine versus mepivacaine for spinal anesthesia in patients undergoing outpatient orthopedic arthroscopic procedures[J].J Clin Anesth,2012,24(2):109-115.2019-01-18
[2]Rivosecci RM,Rice MJ,Simthburger PL,et al.An evidence based systematic review of remifentanil associated opioid-induced hyperalgesia[J].Expert Opin Drug Saf,2014,13(5):587-603.
[3]高志屹,程斌.超声引导下腹横肌平面阻滞用于下腹部手术术后镇痛的效果[J].临床麻醉学杂志,2014,30(12):1190-1192.
[4]Hebbard P.Subcostal transversus abdominis plane block under ultrasound guidance[J].Anesth Analg,2008,106(2):674-675.
[5]Kochs E,Cote D,Deruyck L,et al.Postoperative pain management and recovery after remifentanil-based anesthesia with isoflurane or propofol for major abdominal surgery[J].Br J Anaesth,2000,84(2):169-173.
[6]Wu CL,Raja SN.Treatment of acute postoperative pain[J].Lancet,2011,377(6):2215-2225.
[7]马浩南,李恒林,车伟,等.超声引导腹横肌平面阻滞对全麻子宫切除术病人术后镇痛效果的影响[J].中华麻醉学杂志,2010,30(9):1025-1027.
[8]Liguori GA,Zayas VM,Chisholm MF.Transient neurologic symptoms after spinal anesthesia with mepivacaine and lidocaine[J].Anesthesiology,1998,88(5):619-623.
[9]YaDeau JT,Liguori GA,Zayas VM.The incidence of transient neurologic symptoms after spinal anesthesia with mepivacaine[J].Anesth Analg,2005,101(3):661-665.
[10]Liguori GA,Zayas VM.Repeated episodes of transient radiating back and leg pain following spinal anesthesia with 1.5%mepivacaine and 2%lidocaine[J].Reg Anesth Pain Med,1998,23(5):511-515.
[11]Pawlowski J,Orr K,Kim K,et al.Anesthetic and recovery profiles of lidocaine versus mepivacaine for spinal anesthesia in patients undergoing outpatient orthopedic arthroscopic procedures[J].J Clin Anesth,2012,24(2):109-115.2019-01-18