羅哌卡因聯合地塞米松局部浸潤改善骨與關節手術后鎮痛效果

張超　 謝宗平　金東旭　 張長青

200233，　　上海交通大學附屬第六人民醫院骨科

?

羅哌卡因聯合地塞米松局部浸潤改善骨與關節手術后鎮痛效果

張超 謝宗平金東旭 張長青

200233，上海交通大學附屬第六人民醫院骨科

【摘要】目的探討羅哌卡因聯合地塞米松手術區域局部浸潤鎮痛能否改善骨與關節手術后疼痛及減少術后口服鎮痛藥量。 方法將2014年6月至8月我院51例需行骨關節手術患者隨機分成兩組，實驗組術中局部浸潤0.1%羅哌卡因20 mL(200 mg)聯合地塞米松2 mg,對照組術中局部浸潤等量生理鹽水。記錄患者術后4、8、12、24、48 h疼痛視覺模擬評分(VAS),給予自覺疼痛難忍者口服鎮痛藥。主要評價指標為術后VAS評分；次要評價指標為口服鎮痛藥物劑量及首次口服鎮痛藥物距手術結束時間、術后不良反應、總體滿意度等。結果實驗組與對照組術后8、12、24、48 h VAS評分有統計學差異，兩組口服奇曼丁總劑量、總體滿意度有統計學差異。結論羅哌卡因聯合地塞米松手術區域局部浸潤可顯著降低骨與關節手術后靜息疼痛，減少需使用鎮痛藥物的人數，延遲術后鎮痛藥物應用時間，減少鎮藥物使用劑量。

【關鍵詞】骨與關節手術；麻醉；鎮痛；局部浸潤

The analgesic effect of intraoperative wound infiltration with ropivacaine and dexamethasone after bone and joint surgeryZHANGChao,XIEZong-ping,JINDong-xu,ZHANGChang-qing.

Departmentoforthopaedics,theSixthPeople’sHospitalAffiliatedtoShanghaiJiaotongUniversity,Shanghai200233,China

Correspondingauthor:ZHANGChang-qingE-mail:zhangcq6th@gmail.com

【Abstract】ObjectiveTo evaluate the analgesic effect of intraoperative wound infiltration with ropivacaine and dexamethasone after bone and joint surgery. Methods From June to August 2014, 51 patients were randomized into two groups. At the end of suegery, 20 mL 0.1% ropivacaine (200 mg) and dexamethasone (2 mg) or saline was respectively infiltrated in two groups. The visual analog scales (VAS) scores at 4,8,12,24 and 48 h after surgery were recorded, and the patients were administered with analgesics if the patients thought the pain had a negative effect on rest. The primary endpoints were the VAS scores at 4，8，12，24 and 48 h. The secondary endpoints were total dose of analgesics, time of analgesics consumption, side-effects and gross satisfaction scales. Results The VAS scores at 8,12,24 and 48 h after surgery while resting, total dose of analgesics, time of analgesics consumption, side-effects and gross satisfaction scales were statistically different between two groups. Conclusion Ropivacaine and dexamethasone wound infiltration could reduce postoperative pain and analgesics requirements during the first 48 hours after surgery.

【Key words】Bone and joint surgery; Anesthesia; Analgesia; Local infiltration

骨與關節手術患者術后常出現中至重度疼痛[1]，合理有效的術后鎮痛可減輕疼痛并縮短患者住院時間。傳統術后鎮痛方式為：經靜脈自控鎮痛，硬膜外自控鎮痛，外周神經區域阻滯鎮痛，口服或靜脈、肌肉注射非甾體類抗炎藥或阿片類藥物陣痛。然而，這些鎮痛方式往往會引起惡心、嘔吐、尿潴留、肢體運動阻滯等不良反應[2-4]。……