• 四川省醫(yī)學科學院·四川省人民醫(yī)院麻醉科（成都，610072）;

【摘要】　目的　 評估羅哌卡因切口預注射聯(lián)合曲馬多對腹腔鏡下膽囊切除術（laparoscopic cholecystectomy，LC）術后疼痛的影響。　方法　 選取2010年6月-2011年4月行擇期LC患者120例，年齡18~65歲，美國麻醉師協(xié)會Ⅰ~Ⅱ級，采用完全隨機的設計分組：0.75%羅哌卡因10 mL切口注射+術畢靜脈注射曲馬多（2 mg/kg）組（A組，n=30）；生理鹽水10 mL切口注射+術畢靜脈注射曲馬多（2 mg/kg）組（B組，n=30）；0.75%羅哌卡因10 mL切口注射+術畢靜脈注射生理鹽水10 mL組（C組，n=30）；生理鹽水組（D組，n=30）。術后2、4、6、12、24 h分別評估右上腹部、右肩背部和腹壁切口疼痛進行視覺模擬評分（visual analog scale，VAS）。　結果　 右上腹部及右肩背部疼痛VAS比較：與D組相比，A、B組VAS評分明顯減少（P lt;0.05），而C組無明顯統(tǒng)計學差異（P gt;0.05）；B組與A組相比，2~24 h VAS評分明顯增加（P lt;0.05）；C組與A組相比，2~24 h VAS評分增高（P lt;0.01）。腹壁切口疼痛VAS比較:與D組相比，A、B、C組VAS評分明顯減少（P lt;0.05）；B組與A組相比，2~24 h VAS評分明顯增加（P lt;0.05）；C組與A組相比，2~24 h VAS評分顯著增高（P lt;0.01）。　結論　 腹腔鏡膽囊切除術術前切口羅哌卡因預注射-術畢曲馬多靜脈注射對減輕術后疼痛有良好效果。
【Abstract】　Objective　 To evaluate the effects of preincisional ropivacaine plus tramadol intravenous injection on postoperative pain relief after laparoscopic cholecystectomy (LC).　Methods　 One hundred and twenty patients aged between 18 and 65 years old with an ASA score from Ⅰ to Ⅱ who underwent elective laparoscopic cholecystectomy from June 2010 to April 2011 comprised this study. The patients were randomly divided into four groups with 30 in each group. Patients in group A had an infusion of 0.75% ropivacaine (10 mL) at the beginning of LC plus tramadol (2 mg/kg) intravenous injection at the end. Group B patients had an infusion of normal saline 0.9% (10 mL) at the beginning of LC plus tramadol (2 mg/kg) intravenous injection at the end. Patients in group C had an infusion of 0.75% ropivacaine (10 mL) at the beginning of LC plus normal saline 0.9% (10 mL) intravenous injection at the end. Group D (control group) patients had neither ropivacaine nor tramadol infusion. Pain in the right upper abdomen, right shoulder tip and abdominal incision were assessed at hour 2, 4, 6, 12, and 24 postoperatively using a visual analog score (VAS).　Results　 Right upper abdomen and right shoulder tip pain VAS comparison: significantly lower pain scores were observed in group A and B (P lt;0.05) than in group D (P gt;0.05). Group A had significantly lower pain scores than group B (P lt;0.05) and C (P lt;0.01) at postoperative hours 2, 4, 6, 12, and 24. Abdominal incision pain VAS comparison: VAS scores were significantly lower in group A, B and C than in group D (P lt;0.05). Group A had significantly lower pain scores than group B (P lt;0.05) and C (P lt;0.01) at postoperative hours 2, 4, 6, 12, and 24.　Conclusion　 Preincisional ropivacaine at the beginning of LC combined with tramadol intravenous injection at the end can effectively alleviate postoperative pain after laparoscopic cholecystectomy.

引用本文： 陳江山,曾思,文傳兵,蘭志勛. 羅哌卡因切口預注射聯(lián)合曲馬多對腹腔鏡下膽囊切除術后疼痛的影響. 華西醫(yī)學, 2011, 26(12): 1864-1867. doi: 復制

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7. 　Papagiannopoulou P, Argiriadou H, Georgiou M, et al. Preincisional local infiltration of levobupivacaine vs ropivacaine for pain control after laparoscopic cholecystectomy[J]. Surg Endosc, 2003, 17(12): 1961-1964.
8. 　Sacerdote P, Bianchi M, Gaspani L, et al. The effects of tramadol and morphine on immune responses and pain after surgery in cancer patients[J]. Anesth Analg, 2000, 90(6): 1411-1414.
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10. 　Tsimoyiannis EC, Siakas P, Tassis A, et al. Intraperitoneal normal saline infusion for postoperative pain after laparoscopic cholecystectomy[J]. World J Surg, 1998, 22(8): 824-828.
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  2. 2. 　Dahl JB, Moiniche S. Pre-emptive analgesia[J]. Br Med Bull, 2004, 71(1): 13-27.
  3. 3. 　Ong CK, Lirk P, Seymour RA, et al. The efficacy of pre-emptive analgesia for acute postoperative pain management: a meta analysis[J]. Anesth Analg, 2005, 100(3): 757-773.
  4. 4. 　Karaaslan D, S ivaci RG, Ak bulut G, et al.Pre-emptive analgesia in laparoscopic cholecystectomy: a randomized controlled study[J]. Pain Pract, 2006, 6(4): 237-241.
  5. 5. 　任先告. 局部麻醉藥在腹腔鏡中膽囊切除術中的應用[J]. 華西醫(yī)學, 2009, 24(11): 2871-2872.
  6. 6. 　Pappas-Gogos G, Tsimogiannis KE, Zikos N, et al. Preincisional and intraperitoneal ropivacaine plus normal saline infusion for postoperative pain relief after laparoscopic cholecystectomy: a randomized double-blind controlled trial[J]. Surg Endosc, 2008, 22(9): 2036-2045.
  7. 7. 　Papagiannopoulou P, Argiriadou H, Georgiou M, et al. Preincisional local infiltration of levobupivacaine vs ropivacaine for pain control after laparoscopic cholecystectomy[J]. Surg Endosc, 2003, 17(12): 1961-1964.
  8. 8. 　Sacerdote P, Bianchi M, Gaspani L, et al. The effects of tramadol and morphine on immune responses and pain after surgery in cancer patients[J]. Anesth Analg, 2000, 90(6): 1411-1414.
  9. 9. 　Jackson SA, Laurence AS, Hill JC. Does post-laparoscopy pain relate to residual carbon dioxide?[J]. Anaesthesia, 1996, 51(5): 485-487.
  10. 10. 　Tsimoyiannis EC, Siakas P, Tassis A, et al. Intraperitoneal normal saline infusion for postoperative pain after laparoscopic cholecystectomy[J]. World J Surg, 1998, 22(8): 824-828.