罗哌卡因复合液持续浸润镇痛在腰椎内固定术后的应用效果观察
|
摘要
目的观察罗哌卡因复合液持续浸润镇痛在腰椎内固定术后的应用效果。方法将80例行后路腰椎内固定术的患者随机分为观察组与对照组,每组40例。观察组术后采用罗哌卡因复合液持续浸润镇痛,对照组采用静脉镇痛泵镇痛。比较两组患者术前、术后清醒即刻、术后3 h、术后6 h、术后12 h、术后24 h、术后48 h及首次下地行康复锻炼后6 h的疼痛视觉模拟量表(VAS)评分。比较术后48 h内两组患者阿片类及非甾体类药物用量,观察两组患者术后不良反应发生情况。结果观察组术后各时间点的VAS评分均低于对照组(均P <0. 05)。观察组术后48 h内曲马多注射液及特耐用量均低于对照组,术后不良反应发生率低于对照组(均P <0. 05)。结论腰椎后路内固定术后采用罗哌卡因复合液伤口持续浸润镇痛效果确切,可降低患者术后疼痛及不良反应发生率,并能减少术后止痛药物用量。
Objective To observe the application efficacy of continuous infiltration analgesia with ropivacaine compound solution following lumbar internal fixation. Methods Eighty patients undergoing posterior lumbar internal fixation were randomly divided into observation group and control group,with 40 cases in each group. The observation group was given ropivacaine compound solution for continuous infiltration analgesia after operation,while the control group was given intravenous analgesia pump for analgesia. Pain Visual Analogue Scale( VAS) scores were compared between the two groups before operation,immediately after postoperative recovery from anesthesia,3,6,12,24 and 48 hours after operation,as well as 6 hours after rehabilitation exercise following the first ambulation. The consumption of opioids and non-steroidal drugs was compared between the two groups within 48 hours after operation,and the incidence of postoperative adverse reactions was observed in the two groups. Results The VAS scores in the observation group at each time point after operation were lower than those in the control group( all P < 0. 05). The observation group had lower consumption of Tramadol Injection and parecoxib within 48 hours after operation,as well as lower incidence rate of postoperative adverse reactions than the control group( all P < 0. 05). Conclusion After lumbar posterior internal fixation,applying continuous infiltration of ropivacaine compound solution to wound analgesia has definite efficacy,which can reduce the incidence rates of postoperative pain and adverse reactions as well as decrease the consumption of postoperative analgesics.
Objective To observe the application efficacy of continuous infiltration analgesia with ropivacaine compound solution following lumbar internal fixation. Methods Eighty patients undergoing posterior lumbar internal fixation were randomly divided into observation group and control group,with 40 cases in each group. The observation group was given ropivacaine compound solution for continuous infiltration analgesia after operation,while the control group was given intravenous analgesia pump for analgesia. Pain Visual Analogue Scale( VAS) scores were compared between the two groups before operation,immediately after postoperative recovery from anesthesia,3,6,12,24 and 48 hours after operation,as well as 6 hours after rehabilitation exercise following the first ambulation. The consumption of opioids and non-steroidal drugs was compared between the two groups within 48 hours after operation,and the incidence of postoperative adverse reactions was observed in the two groups. Results The VAS scores in the observation group at each time point after operation were lower than those in the control group( all P < 0. 05). The observation group had lower consumption of Tramadol Injection and parecoxib within 48 hours after operation,as well as lower incidence rate of postoperative adverse reactions than the control group( all P < 0. 05). Conclusion After lumbar posterior internal fixation,applying continuous infiltration of ropivacaine compound solution to wound analgesia has definite efficacy,which can reduce the incidence rates of postoperative pain and adverse reactions as well as decrease the consumption of postoperative analgesics.
引文
[1]王诗军,李钰婷,李淳德,等.腰椎椎弓根钉内固定植骨融合术中伤口周围注射罗哌卡因复合液的镇痛效应[J].中国组织工程研究,2014,18(48):7 769-7 774.
[2]徐波,任莉,王智运,等.左旋布比卡因伤口局部持续输注用于脊柱手术后的镇痛效果[J].临床麻醉学杂志,2014,30(4):327-329.
[3] Costantini R,Affaitati G,Fabrizio A,et al. Controlling pain in the post-operative setting[J]. Int J Clin Pharmacol Ther,2011,49(2):116-127.
[4] Elvir-Lazo OL,White PF. Postoperative pain management after ambulatory surgery:role of multimodal analgesia[J].Anesthesiol Clin,2010,28(2):217-224.
[5] Murray CJ,Abraham J,Ali MK,et al. The state of US health,1990-2010 burden of diseases,injuries,and risk factors[J].JAMA,2013,310(6):591-608.
[6]迟晓慧,陈永学.罗哌卡因复合倍他米松局部浸润在腰椎后路手术后镇痛的疗效[J].中国中西医结合外科杂志,2016,22(3):290-292.
[7]鲁尧,林新源,黄瑞玉.腰椎融合术伤口浸润罗哌卡因混合液对术后镇痛的临床观察[J].黑龙江医药,2017,30(3):585-587.
[8]张奎渤,朱颖娴,郭远清,等.围术期多模式镇痛在腰椎后路内固定融合术中的应用[J].第三军医大学学报,2014,36(13):1 424-1 427.
[9]杨智伟,史晓娟,郭力,等.加速康复外科在腰椎融合手术中的应用研究[J].骨科,2017,8(2):127-131.
[10] Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation[J]. Br J Anaesth,1997,78(5):606-617.
[11]杨万玲.快速康复外科护理临床应用现状及启示[J].安徽医学,2013,34(10):1 581-1 583.
[12]周弘峰,佘守章,谢晓青.氟比洛芬酯用于颈椎后-前路联合手术术后镇痛的临床研究[J].广东医学,2010,31(1):110-112.
[13]张啟维,薛庆云,王强,等.帕瑞昔布在后路腰椎融合术后多模式镇痛中的临床应用[J].中国脊柱脊髓杂志,2010,20(10):855-859.
[14]谢佳芯,周琦,付奇伟,等.膝关节单髁置换术中关节周围注射镇痛混合剂的应用研究[J].中华关节外科杂志(电子版),2014,8(6):702-707.
[15]曾金才,孙俊英,杨立文,等.关节内置管局部浸润镇痛在全膝关节置换术的应用[J].中国矫形外科杂志,2009,17(21):1 609-1 612.
[16] Kerr DR,Kohan L. Local infiltration analgesia:a technique for the control of acute postoperative pain following knee and hip surgery:a case study of 325 patients[J]. Acta Orthop,2008,79(2):174-183.
[17]唐向盛,移平,杨峰,等.罗哌卡因在后路腰椎融合术多模式镇痛中的临床应用[J].中国矫形外科杂志,2017,25(1):20-24.
[18] Blumenthal S,Borgeat A,Pasch T,et al. Ropivacaine decreases inflammation in experimental endotoxin-induced lung injury[J]. Anesthesiology,2006,104(5):961-969.
[19] Karaman S,Kocaba S,Ergun S,et al. Intraperitoneal ropivacaine or ropivacaine plus meperidine for laparoscopic gynecological procedures[J]. Agri,2013,24(2):56-62.
[2]徐波,任莉,王智运,等.左旋布比卡因伤口局部持续输注用于脊柱手术后的镇痛效果[J].临床麻醉学杂志,2014,30(4):327-329.
[3] Costantini R,Affaitati G,Fabrizio A,et al. Controlling pain in the post-operative setting[J]. Int J Clin Pharmacol Ther,2011,49(2):116-127.
[4] Elvir-Lazo OL,White PF. Postoperative pain management after ambulatory surgery:role of multimodal analgesia[J].Anesthesiol Clin,2010,28(2):217-224.
[5] Murray CJ,Abraham J,Ali MK,et al. The state of US health,1990-2010 burden of diseases,injuries,and risk factors[J].JAMA,2013,310(6):591-608.
[6]迟晓慧,陈永学.罗哌卡因复合倍他米松局部浸润在腰椎后路手术后镇痛的疗效[J].中国中西医结合外科杂志,2016,22(3):290-292.
[7]鲁尧,林新源,黄瑞玉.腰椎融合术伤口浸润罗哌卡因混合液对术后镇痛的临床观察[J].黑龙江医药,2017,30(3):585-587.
[8]张奎渤,朱颖娴,郭远清,等.围术期多模式镇痛在腰椎后路内固定融合术中的应用[J].第三军医大学学报,2014,36(13):1 424-1 427.
[9]杨智伟,史晓娟,郭力,等.加速康复外科在腰椎融合手术中的应用研究[J].骨科,2017,8(2):127-131.
[10] Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation[J]. Br J Anaesth,1997,78(5):606-617.
[11]杨万玲.快速康复外科护理临床应用现状及启示[J].安徽医学,2013,34(10):1 581-1 583.
[12]周弘峰,佘守章,谢晓青.氟比洛芬酯用于颈椎后-前路联合手术术后镇痛的临床研究[J].广东医学,2010,31(1):110-112.
[13]张啟维,薛庆云,王强,等.帕瑞昔布在后路腰椎融合术后多模式镇痛中的临床应用[J].中国脊柱脊髓杂志,2010,20(10):855-859.
[14]谢佳芯,周琦,付奇伟,等.膝关节单髁置换术中关节周围注射镇痛混合剂的应用研究[J].中华关节外科杂志(电子版),2014,8(6):702-707.
[15]曾金才,孙俊英,杨立文,等.关节内置管局部浸润镇痛在全膝关节置换术的应用[J].中国矫形外科杂志,2009,17(21):1 609-1 612.
[16] Kerr DR,Kohan L. Local infiltration analgesia:a technique for the control of acute postoperative pain following knee and hip surgery:a case study of 325 patients[J]. Acta Orthop,2008,79(2):174-183.
[17]唐向盛,移平,杨峰,等.罗哌卡因在后路腰椎融合术多模式镇痛中的临床应用[J].中国矫形外科杂志,2017,25(1):20-24.
[18] Blumenthal S,Borgeat A,Pasch T,et al. Ropivacaine decreases inflammation in experimental endotoxin-induced lung injury[J]. Anesthesiology,2006,104(5):961-969.
[19] Karaman S,Kocaba S,Ergun S,et al. Intraperitoneal ropivacaine or ropivacaine plus meperidine for laparoscopic gynecological procedures[J]. Agri,2013,24(2):56-62.