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利多卡因浸润在全身麻醉下进行的显微耳部手术中真的有必要吗?

Is Lidocaine Infiltration Really Necessary in Micro Ear Surgeries performed Under General Anaesthesia?

作者信息

Senthil K, Samuel John, Ramachandran V V

机构信息

Department Of ENT, Head & Neck Surgery, Sri Ramachandra University, Porur, Chennai, 116 India.

出版信息

Indian J Otolaryngol Head Neck Surg. 2012 Dec;64(4):333-7. doi: 10.1007/s12070-011-0328-1. Epub 2011 Nov 27.

Abstract

To study the role of infiltrating 2% Lidocaine in Micro ear surgeries performed under general anaesthesia. To measure the impact of infiltration of 2% Lidocaine in post operative pain relief and per operative bleeding. A Double blinded, Prospective randomized comparative study was conducted in a tertiary care referral centre. A total of 30 patients planned for micro ear surgeries under general anaesthesia (Tympanoplasty and Cortical mastoidectomy) for CSOM tubotympanic disease were selected and divided into two groups randomly by the chief senior consultant. Group A patients received local infiltration of 2% Lidocaine with one in 200,000 adrenaline and Group B patients received infiltration of one in 200,000 adrenaline in distilled water alone. Operating surgeon assessed the bleeding in the surgical field using Boezaart's grading system. Post operative pain was assessed using a visual analog scale. Pain scores of these patients were assessed in the 1st, 4 and 24th h post operatively and recorded. The mean post operative pain score in the 1st h for the patients in Group A was 0.93 and for patients in Group B was two. The difference in the pain scores between the two groups was significant (P < 0.02).The difference in the mean post operative pain scores between the two groups in the 4 and 24th h were not significant (P < 0.1).Per operatively, grade III bleeding was present in 73% of patients in group B and only 33% of patients had grade III bleeding in group A. Infiltration of 2% Lidocaine has a significant impact over the grade of bleeding in the operative field and also on 1st h post operative pain relief. It did not have a significant influence on the pain relief in the 4 and 24th h post operatively.

摘要

研究浸润2%利多卡因在全身麻醉下进行的微型耳部手术中的作用。测量2%利多卡因浸润对术后疼痛缓解和术中出血的影响。在一家三级医疗转诊中心进行了一项双盲、前瞻性随机对照研究。总共选取了30例计划在全身麻醉下进行微型耳部手术(鼓膜成形术和皮质乳突切除术)治疗慢性化脓性中耳炎管鼓室疾病的患者,并由首席高级顾问随机分为两组。A组患者接受含1:200000肾上腺素的2%利多卡因局部浸润,B组患者仅接受含1:200000肾上腺素的蒸馏水浸润。手术医生使用博扎尔特分级系统评估手术视野中的出血情况。使用视觉模拟量表评估术后疼痛。在术后第1、4和24小时评估这些患者的疼痛评分并记录。A组患者术后第1小时的平均疼痛评分为0.93,B组患者为2。两组疼痛评分差异有统计学意义(P<0.02)。两组在术后第4和24小时的平均术后疼痛评分差异无统计学意义(P<0.1)。术中,B组73%的患者出现Ⅲ级出血,而A组只有33%的患者出现Ⅲ级出血。2%利多卡因浸润对手术视野出血分级以及术后第1小时的疼痛缓解有显著影响。它对术后第4和24小时的疼痛缓解没有显著影响。

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