利多卡因联合复方倍他米松局部浸渍对肛瘘切开挂线术后疼痛的影响
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摘要
目的探讨利多卡因联合复方倍他米松局部浸渍对肛瘘切开挂线术后疼痛的影响。方法选取北京市肛肠医院2016年1月—2018年3月收治的行肛瘘切开挂线术患者160例,随机分为对照组和试验组,各80例。对照组患者给予0.9%氯化钠溶液治疗,试验组患者给予利多卡因联合复方倍他米松治疗。比较两组患者术后1、6、24、48、72 h和术后第一次排尿及排便时视觉模拟量表(VAS)评分,氨酚羟考酮和吗啡用量、住院时间及伤口愈合时间,并观察两组患者并发症发生情况。结果两组患者术后1、48、72 h及术后第一次排尿VAS评分比较,差异无统计学意义(P>0.05);试验组患者术后6、24 h及术后第一次排便VAS评分低于对照组(P<0.05)。两组患者吗啡用量、住院时间、伤口愈合时间比较,差异无统计学意义(P>0.05);试验组患者氨酚羟考酮用量小于对照组(P<0.05)。两组患者并发症发生率比较,差异无统计学意义(P>0.05)。结论利多卡因联合复方倍他米松局部浸渍可减轻肛瘘切开挂线术后患者疼痛,且安全性较高,但对创面愈合、住院时间无明显影响。
Objective To investigate the effect of lidocaine combined with compound betamethasone local impregnation on pain after anal fistula incision and thread-drawing.Methods A total of 160 cases of patients underwent anal fistula incision and thread-drawing were selected from January 2016 to March 2018 in Beijing coloproctological Hospital,which were randomly divided into control group and experimental group,80 cases in each group.The control group was treated with 0.9%sodium chloride solution,while the experimental group was treated with lidocaine combined with compound betamethasone.The VAS scores at after operation of 1,6,24,48,72 hours,the first urination and defecation were compared between the two groups;oxycodone aminophend,morphine dosage,hospitalization time and wound healing time were compared between the two groups,and the complications were observed between the two groups.Results There was no significant differences of the VAS score at after operation of 1,48,72 hours or the first urination between the two groups(P>0.05);the experimental group of the VAS score at after operation of 6 and 24 hours and first defecation was lower than control group(P<0.05).There was no significant differences in morphine dosage,hospitalization time or wound healing time between the two groups(P>0.05);the experimental group of the dosage of oxycodone aminophend was less than control group(P<0.05).There was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusion Lidocaine combined with compound betamethasone local impregnation can alleviate the pain after anal fistula incision and thread-drawing,and with high safecty,but it has no significant effect on wound healing and hospitalization time.
Objective To investigate the effect of lidocaine combined with compound betamethasone local impregnation on pain after anal fistula incision and thread-drawing.Methods A total of 160 cases of patients underwent anal fistula incision and thread-drawing were selected from January 2016 to March 2018 in Beijing coloproctological Hospital,which were randomly divided into control group and experimental group,80 cases in each group.The control group was treated with 0.9%sodium chloride solution,while the experimental group was treated with lidocaine combined with compound betamethasone.The VAS scores at after operation of 1,6,24,48,72 hours,the first urination and defecation were compared between the two groups;oxycodone aminophend,morphine dosage,hospitalization time and wound healing time were compared between the two groups,and the complications were observed between the two groups.Results There was no significant differences of the VAS score at after operation of 1,48,72 hours or the first urination between the two groups(P>0.05);the experimental group of the VAS score at after operation of 6 and 24 hours and first defecation was lower than control group(P<0.05).There was no significant differences in morphine dosage,hospitalization time or wound healing time between the two groups(P>0.05);the experimental group of the dosage of oxycodone aminophend was less than control group(P<0.05).There was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusion Lidocaine combined with compound betamethasone local impregnation can alleviate the pain after anal fistula incision and thread-drawing,and with high safecty,but it has no significant effect on wound healing and hospitalization time.
引文
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[2]TAN K Y,SNG K K,TAY K H,et al.Randomized clinical trial of0.2 per cent glyceryl trinitrate ointment for wound healing and pain reduction after open diathermy haemorrhoidectomy[J].Br J Surg,2006,93(12):1464-1468.
[3]SCOTT N B.Wound infiltration for surgery[J].Anaesthesia,2010,65(Suppl 1):67-75.
[4]KIRCHHOFF P,CLAVIEN P A,HAHNLOSER D.Complications in colorectal surgery:risk factors and preventive strategies[J].Patient Saf Surg,2010,4(1):5.
[5]SCHUG S A,MANOPAS A.Update on the role of nonopioids for postoperative pain treatment[J].Best Pract Res Clin Anaesthesiol,2007,21(1):15-30.
[6]MAUND E,MCDAID C,RICE S,et al.Paracetamol and selective and non-selective non-steroidal anti-inflammatory drugs for the reduction in morphinerelated side-effects after major surgery:a systematic review[J].Br J Anaesth,2011,106(3):292-297.
[7]UZZAMAN M M,SIDDIQUI M R S.A brief literature review on the management of posthaemorrhoidectomy pain[J].Surgical Techniques Development,2011,1(2):32.
[8]RAINES S,HEDLUND C,FRANZON M,et al.Ropivacaine for continuous wound infusion for postoperative pain management:a systematic review and metaanalysis of randomized controlled trials[J].Eur Surg Res,2014,53(1/4):43-60.
[9]BUGADA D,DE GREGORI M,COMPAGNONE C,et al.Continuous wound infusion of local anesthetic and steroid after major abdominal surgery:study protocol for a randomized controlled trial[J].Trials,2015,(16):357.
[10]WOLF G,LIVSHITS D,BEILIN B,et al.Interleukin-1 signaling is required for induction and maintenance of postoperative incisional pain:genetic and pharmacological studies in mice[J].Brain Behav Immun,2008,22(7):1072-1077.
[11]NICHOLSONG,HALLG M.Effectsof anaesthesiaonthe inflammatory response to injury[J].Curr Opin Anaesthesiol,2011,24(4):370-374.
[12]LI H,XIE W,STRONG J A,et al.Systemic antiinflammatory corticosteroid reduces mechanical pain behavior,sympathetic sprouting,and elevation of proinflammatory cytokines in a rat model of neuropathic pain[J].Anesthesiology,2007,107(3):469-477.
[13]MATHIESENO,WETTERSLEVJ,KONTINENV K,et al.Adverse effects of perioperative paracetamol,NSAIDs,glucocorticoids,gabapentinoids and their combinations:a topical review[J].Acta Anaesthesiol Scand,2014,58(10):1182-1198.