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| 布比卡因脂质体与罗哌卡因行腹横肌平面阻滞在结直肠癌根治术后镇痛中的比较 |
| Comparison of liposomal bupivacaine and ropivacaine for transversus abdominis plane block in analgesia after radical resection of colorectal cancer |
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| DOI：10.12089/jca.2025.02.007 |
| 中文关键词: 布比卡因脂质体 罗哌卡因 腹横肌平面阻滞 结直肠癌根治术 术后镇痛 |
| 英文关键词: Liposomal bupivacaine Ropivacaine Transversus abdominis plane block Radical resection of colorectal cancer Postoperative analgesia |
| 基金项目:河南省卫生计生科技英才海外研修工程（HWXY2019155） |
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| 中文摘要: |
目的：比较布比卡因脂质体与罗哌卡因行腹横肌平面阻滞（TAPB）用于腹腔镜结直肠癌根治术后早期镇痛的有效性及安全性。
方法：选择择期行结直肠癌根治术的患者96例，男60例，女36例，年龄18～64岁，BMI 18.5～28.0 kg/m2，ASA Ⅰ或Ⅱ级。采用随机数字表法将患者分为两组：布比卡因脂质体组（L组， n=48）和罗哌卡因组（R组， n=48）。手术结束后麻醉苏醒前，在超声引导下行TAPB，L组使用0.665%布比卡因脂质体，R组使用0.2%罗哌卡因，每侧均为20 ml。术毕连接镇痛泵行舒芬太尼PCIA。记录术中舒芬太尼、瑞芬太尼用量及PACU停留时间；术后0～24、24～48、0～48、48～72和0～72 h舒芬太尼用量。记录术后1、6、24、48、72 h冷试验感觉阻滞阳性结果和术后1、6、12、24、48、72 h静息和活动时NRS评分。记录术后首次按压镇痛泵时间、补救镇痛例数、首次下床活动时间、首次肛门排气时间、首次排便时间、恶心呕吐、头晕和嗜睡的发生情况。
结果：与R组比较，L组术后24~48、0～48、48~72和0～72 h舒芬太尼用量明显减少；术后24、48、72 h冷试验感觉阻滞阳性率明显升高；首次下床活动时间和首次肛门排气时间明显缩短；恶心呕吐发生率明显降低（P<0.05）。两组术中舒芬太尼用量、瑞芬太尼用量、PACU停留时间、术后不同时点静息和活动时NRS评分、首次按压镇痛泵时间、补救镇痛例数、首次排便时间及头晕和嗜睡的发生率差异均无统计学意义。
结论：布比卡因脂质体行TAPB用于腹腔镜结直肠癌根治术后镇痛，可以在减少术后阿片类药物用量的同时降低不良反应的发生率。 |
| 英文摘要: |
Objective: To compare the efficacy and safety of liposomal bupivacaine and ropivacaine for transversus abdominis plane block (TAPB) in early postoperative analgesia after laparoscopic radical resection of colorectal cancer.
Methods: Ninety-six patients, 60 males and 36 females, aged 18-64 years, BMI 18.5-28.0 kg/m2, ASA physical status Ⅰ or Ⅱ, undergoing laparoscopic radical resection of colorectal cancer were selected in this study. The patients were divided into two groups: the liposomal bupivacaine group (group L, n = 48) and the ropivacaine group (group R, n = 48). The TAPB was performed under ultrasound guidance at the end of the operation and before anesthesia awakening. The patients in group L was given 0.665% liposomal bupivacaine, and the patients in group R was given 0.2% ropivacaine, 20 ml in each side. PCIA was performed by connecting the analgesic pump after operation. The intraoperative dosage of sufentanil and remifentanil and PACU residence time were recorded. The sufentanil dosages 0-24, 24-48, 0-48, 48-72, and 0-72 hours after surgery were recorded. The positive Results of cold test sensory block 1, 6, 24, 48, and 72 hours after surgery were recorded. The NRS scores at rest and during activity 1, 6, 12, 24, 48, and 72 hours after operation were recorded. First compression time of analgesic pump and rescue analgesia were recorded. The first ambulation time, the first postoperative exhaust time, the first postoperative defecation time, and the incidence of nausea and vomiting, dizziness and drowsiness were also recorded.
Results: Compared with group R, sufentanil dosages 24-48, 0-48, 48-72, and 0-72 hours after surgery were significantly lower in group L (P < 0.05). Positive Results of cold test sensory block 24, 48, and 72 hours after surgery were higher in group L than in group R (P < 0.05). The first ambulation time and the first postoperative exhaust time were earlier in group L than in group R (P < 0.05). The incidence of nausea and vomiting was significantly lower in group L than in group R (P < 0.05). There were no significant differences between the two groups in the dosages of sufentanil and remifentanil during the operation, PACU residence time, the NRS scores at rest and during activity, the first compression time of analgesic pump, the rescue analgesia, the first postoperative defecation time, and the incidence of dizziness and drowsiness.
Conclusion: Liposomal bupivacaine for TAPB in postoperative analgesia after laparoscopic radical resection of colorectal cancer can reduce the dosage of postoperative opioid drugs and decrease the incidence of adverse reactions. |
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