Liang Han-sheng, Feng Yi, Liu Yi-zhao, An Hai-yan, Yang Ba-xian
Department of Anesthesiology, Peking University People's Hospital, Beijing 100044,China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2011 Oct 18;43(5):753-6.
To investigate the effects of postoperative analgesia after laparoscopic cholecystectomy using intravenous flurbiprofen combined with different concentrations of ropivacaine incision infiltration.
Eighty patients who underwent traditional laparoscopic cholecystectomy received standard general anesthesia. At the end of surgery, patients were randomly divided into four groups: group Con (control group: no analgesics was administered, n=20); group F (flurbiprofen group: 100 mg of flurbiprofen was given intravenously with no incision infiltration, n=20); group FR(0.25) (100 mg of flurbiprofen was given intravenously, combined with 0.25% ropivacaine incision infiltration, 2 mL per incision, 6 mL in total, n=20) and group FR(0.5) (100 mg of flurbiprofen was given intravenously, combined with 0.5% ropivacaine incision infiltration, 2 mL per incision, 6 mL in total, n=20). The intensity of postoperative pain was evaluated using numeric rating scale (NRS) in a double-blinded manner. Intramuscularly 50 mg of meperidin was administered as rescue medication when NRS was above 4. The NRS and the associated side effects were observed and recorded at the end of 0, 2, 6, 12, 24, and 48 hours postoperatively (T(0 h)h,T(2 h),T(6 h),T(12 h),T(24 h),and T(48 h)).
There was no obvious difference among the four groups in respect of gender, age, body weight, baseline blood pressure, heart rate(HR), and total doses of sufentanil and remifentanil during operation and surgical time(P>0.05).There were significant differences among group FR(0.25)(2.34 ± 0.89,3.01 ± 1.27,2.79 ± 0.94), group FR(0.5)(2.42 ± 0.79, 2.69 ± 0.96, 2.03 ± 0.87)and group Con(3.42 ± 1.23, 5.98 ± 1.46, 4.53 ± 0.92)in NRS at T(2 h), T(6 h), and T(12 h)(P<0.05).Systolic blood pressures (SBP) of patients in group FR(0.25) [(114.19 ± .74) mmHg,(108.31 ± 7.62) mmHg) and group FR(0.5) [(115.26 ± 8.95) mmHg,(111.25 ± 9.12) mmHg] were significantly lower than those of patients in group Con [(137.11 ± 8.71) mmHg,(125.16 ± 8.92) mmHg] at T(2 h) and T(6 h)(P<0.05). Compared with group Con [(81.24 ± 6.64) beats/min], heart rate(HR) was also lower in patients of group FR(0.25) [(69.14 ± 5.92) beats/min] and group FR(0.5) [(70.16 ± 5.25) beats/min] at T(6 h)(P<0.05). There was no obvious adverse effect in all the four groups.
Intravenous flurbiprofen combined with ropivacaine infiltration could significantly reduce postoperative pain after laparoscopic cholecystectomy, providing more stable hemodynamics. Compared with 0.25% ropivacaine, 0.5% ropivacaine infiltration combined with intravenous flurbiprofen has better and longer analgesic effects.
探讨静脉注射氟比洛芬联合不同浓度罗哌卡因切口浸润用于腹腔镜胆囊切除术后镇痛的效果。
80例行传统腹腔镜胆囊切除术的患者接受标准全身麻醉。手术结束时，患者被随机分为四组：Con组（对照组：未给予镇痛药，n = 20）；F组（氟比洛芬组：静脉注射100 mg氟比洛芬，未进行切口浸润，n = 20）；FR(0.25)组（静脉注射100 mg氟比洛芬，联合0.25%罗哌卡因切口浸润，每切口2 mL，共6 mL，n = 20）和FR(0.5)组（静脉注射100 mg氟比洛芬，联合0.5%罗哌卡因切口浸润，每切口2 mL，共6 mL，n = 20）。采用数字评分量表（NRS）以双盲方式评估术后疼痛强度当NRS高于4时，肌内注射50 mg哌替啶作为解救药物。在术后0、2、6、12、24和48小时末（T(0 h)、T(2 h)、T(6 h)、T(12 h)、T(24 h)和T(48 h)）观察并记录NRS及相关副作用。
四组患者在性别、年龄、体重、基础血压、心率（HR）、术中舒芬太尼和瑞芬太尼总剂量及手术时间方面无明显差异（P>0.05）。FR(0.25)组（2.34±0.89、3.01±1.27、2.79±0.94）、FR(0.5)组（分别为2.42±0.79、2.69±0.96、2.03±0.87）和Con组（3.42±1.23、5.98±1.46、4.53±0.92）在T(2 h)、T(6 h)和T(12 h)时的NRS存在显著差异（P<0.05）。FR(0.25)组[（114.19±7.74）mmHg，（108.31±7.62）mmHg]和FR(0.5)组[（115.26±8.95）mmHg，（111.25±9.12）mmHg]患者在T(2 h)和T(6 h)时的收缩压显著低于Con组[（137.11±8.7）mmHg，（125.16±8.92）mmHg]（P<0.05）。与Con组[（81.24±6.64）次/分钟]相比，FR(0.25)组[（69.14±5.92）次/分钟]和FR(0.5)组[（70.16±5.25）次/分钟]患者在T(6 h)时的心率也较低（P<0.05）。四组均无明显不良反应。
静脉注射氟比洛芬联合罗哌卡因浸润可显著减轻腹腔镜胆囊切除术后的疼痛，使血流动力学更稳定。与0.25%罗哌卡因相比，0.5%罗哌卡因浸润联合静脉注射氟比洛芬具有更好、更持久的镇痛效果。
