文章摘要
罗哌卡因复合布托啡诺腹横肌平面阻滞对妇科腹腔镜手术患者术后镇痛及早期康复的影响
Effect of butorphanol combined with ropivacaine in transversus abdominis plane block for postoperative analgesia and early rehabilitation following gynecological laparoscopy
  
DOI：10.12089/jca.2020.02.012
中文关键词: 腹横肌平面阻滞  布托啡诺  妇科腹腔镜手术  术后镇痛  早期康复
英文关键词: Transversus abdominis plane block  Butorphanol  Gynecological laparoscopy  Postoperative analgesia  Early rehabilitation
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作者单位E-mail
张鹤晨 050051,石家庄市,河北省人民医院麻醉科  
张静 050051,石家庄市,河北省人民医院麻醉科  
蔚冬冬 050051,石家庄市,河北省人民医院麻醉科  
李攀 050051,石家庄市,河北省人民医院麻醉科  
李建立 050051,石家庄市,河北省人民医院麻醉科  
容俊芳 050051,石家庄市,河北省人民医院麻醉科 rjf13291@163.com 
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中文摘要:
      
目的 评价罗哌卡因复合布托啡诺腹横肌平面(transversus abdominis plane, TAP)阻滞对妇科腹腔镜手术患者术后镇痛及早期康复的影响。
方法 择期全麻下行妇科腹腔镜手术患者60例,年龄18～65岁,体重50～76 kg,ASA Ⅰ或Ⅱ级,采用随机数字表法将患者随机分为两组：罗哌卡因复合布托啡诺组(BR组)和罗哌卡因组(R组),每组30例。所有患者在麻醉诱导后均行双侧TAP阻滞。BR组患者每侧注入0.375％罗哌卡因20 ml+0.1％布托啡诺1 ml,R组患者每侧注入0.375％罗哌卡因20 ml+生理盐水1 ml。记录患者术中丙泊酚及瑞芬太尼用量、术后2、24 h的VAS疼痛评分、术后肠道功能恢复时间、下床活动时间、术后24 h的40项恢复质量(quality of recovery, QoR-40)评分。记录TAP阻滞有关不良反应和术后恶心呕吐的发生情况。
结果 与R组比较,BR组术中瑞芬太尼用量明显减少(P＜0.05),术后2 h的VAS疼痛评分明显降低(P＜0.05),术后24 h的QoR-40评分明显升高(P＜0.05)。两组术中丙泊酚用量、术后肠道功能恢复时间、下床活动时间、术后恶心呕吐发生率差异无统计学意义。两组均无一例TAP阻滞有关不良反应发生。
结论 罗哌卡因复合布托啡诺用于腹横肌平面阻滞可减少术中瑞芬太尼用量,改善术后疼痛,提高患者术后麻醉恢复质量。
英文摘要:
      
Ojective To evaluate the effect of butorphanol combined with ropivacaine in transversus abdominis plane (TAP) block for postoperative analgesia and early rehabilitation following gynecological laparoscopy.
Methods Sixty patients scheduled for elective gynecological laparoscopy under general anesthesia, aged 18-65 years, weighing 50-76 kg, falling into ASA physical status Ⅰ or Ⅱ, were randomly divided into two groups by using random number table method: TAP block either with 0.375％ ropivacaine 20 ml and 0.1％ butorphanol 1 ml (group BR, n = 30) or 0.375％ ropivacaine 20 ml and normal saline 1 ml (group R, n = 30). After anesthetic induction, all the patients were performed bilateral TAP block. The intraoperative consumption of propofol and remifentanil, the VAS scores 2 and 24 h after operation, the recovery time of postoperative intestinal function and normal activity, QoR-40 score 24 h after operation, TAP block-related adverse reactions and postoperative nausea and vomiting were recorded.
Results Compared with group R, the intraoperative consumption of remifentanil, the VAS score 2 h after operation was decreased significantly (P ＜ 0.05). The QoR-40 score in group BR were significantly higher than that in group R (P ＜ 0.05). There was no significant difference in intraoperative consumption of propofol, recovery time of intestinal function and ambulation, postoperative nausea and vomiting in the two groups. There was no TAP block-related adverse reactions happened in the two groups.
Conclusion Combination of butorphanol and ropivacaine used in transversus abdominis plane block can reduce the intraoperative consumption of remifentanil, relieve postoperative pain and improve the quality of recovery after anesthesia.
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