Anantanarayanan Parameswaran, Raja Dharmesh Kumar, Kumar J Naveen, Sneha P, Christabel Amelia, Manikandhan Ramanathan, Elavazhagan Namasivayam
Department of Oral and Maxillofacial Surgery, Meenakshiammal Dental College and Hospital, Maduravoyal, Chennai, India.
J Oral Maxillofac Surg. 2013 Jan;71(1):29-34. doi: 10.1016/j.joms.2012.08.010.
Although ribs provide the best source of cartilage for reconstruction, its harvesting is associated with significant postoperative pain and sometimes incapacitating functional deficit. The lack of studies in the maxillofacial literature on regional analgesia for rib harvests stimulated this study design. This study compared ropivacaine with bupivacaine in providing postoperative analgesia after rib harvest.
Patients who needed rib grafting for maxillofacial reconstructive procedures were enrolled in this prospective, randomized, double-blinded clinical trial. Patients were randomly allocated to 1 of 2 groups with different modalities of anesthesia against a control group. A catheter was embedded in the rib donor site in all patients. Patients in group A received 0.75% ropivacaine, those in group B received 0.5% bupivacaine, and those in croup C patients received normal saline and served as the controls. The outcome variables were the subjective and objective pain scores, the duration of action, and the efficacy of the drugs after rib harvest. Dependent variables were the need for a rescue analgesic by the patient and the duration of hospital stay. The subjective intensity of pain at rest was calculated using the visual analog scale. The objective pain scores at function were evaluated by comparing preoperative with postoperative values of incentive spirometry, breath-holding test, maximal chest expansion, and match-blowing test. The t test and paired samples test were used to the analyze data, and a P value less than .05 was considered significant.
Forty-two patients were enrolled in this study. Patients in groups A and B showed significant pain relief compared with group C. Patients in group A showed significantly less pain at rest (2.8±0.894) compared with those in group B (3.7±0.875; P<.05). Patients in group A also showed significantly less in pain at function (3.8±0.894) compared with those in group B (4.7±0.923; P<.05). Patients in group A showed a minimal need for a rescue bolus compared with those in group B. The duration of action for ropivacaine was longer by a mean difference of 11 hours. No noteworthy difference was seen for the duration of stay in the hospital.
The use of catheter-based analgesia after rib harvesting provides excellent postoperative comfort, with ropivacaine providing an earlier return to normal function compared with bupivacaine. The duration of action of ropivacaine was significantly longer and, hence, decreased the need for rescue analgesics.
尽管肋骨是重建手术中软骨的最佳来源，但其采集会导致明显的术后疼痛，有时还会造成功能障碍。颌面文献中缺乏关于肋骨采集区域镇痛的研究，促使了本研究的设计。本研究比较了罗哌卡因和布比卡因在肋骨采集后提供术后镇痛的效果。
需要进行颌面重建手术肋骨移植的患者被纳入这项前瞻性、随机、双盲临床试验。患者被随机分配到两组中的一组，采用不同的麻醉方式，并与对照组进行比较。所有患者均在肋骨供区植入一根导管。A组患者接受0.75%的罗哌卡因，B组患者接受0.5%的布比卡因，C组患者接受生理盐水作为对照。观察指标为肋骨采集后的主观和客观疼痛评分、作用持续时间以及药物疗效。相关变量为患者对急救镇痛药的需求和住院时间。静息时的主观疼痛强度采用视觉模拟量表进行计算。通过比较术前和术后激励肺活量测定、屏气试验、最大胸廓扩张和吹火柴试验的值来评估功能时的客观疼痛评分。采用t检验和配对样本检验分析数据，P值小于0.05被认为具有统计学意义。
本研究共纳入42例患者。与C组相比，A组和B组患者的疼痛明显减轻。A组患者静息时的疼痛（2.8±0.894）明显低于B组（3.7±0.875；P<0.05）。A组患者功能时的疼痛（3.8±0.894）也明显低于B组（4.7±0.923；P<0.05）。与B组相比，A组患者对急救推注药物的需求最小。罗哌卡因的作用持续时间平均长11小时。住院时间未见明显差异。
肋骨采集后采用导管镇痛可提供极佳的术后舒适度，与布比卡因相比，罗哌卡因能使患者更早恢复正常功能。罗哌卡因的作用持续时间明显更长，因此减少了对急救镇痛药的需求。
