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术前左旋布比卡因浸润对阑尾炎患者拔管舒适度、术后恢复及视觉模拟评分的影响

The Effects of Preincisional Levobupivacaine Infiltration on Extubation Comfort, Postoperative Recovery and Visual Analogue Scale in Appendectomy Patients.

作者信息

Güneş Hacı Yusuf, Çeğin Muhammed Bilal

机构信息

Department of Anaesthesiology and Reanimation, İpekyolu City Hospital, Van, Turkey.

Department of Anaesthesiology and Reanimation, Yüzüncü Yıl University Faculty of Medicine, Van, Turkey.

出版信息

Turk J Anaesthesiol Reanim. 2015 Feb;43(1):20-3. doi: 10.5152/TJAR.2014.83702. Epub 2014 Sep 9.

Abstract

OBJECTIVE

The aim of our study was to determine the effect of preincisional 0.25% levobupivacaine infiltration on extubation comfort, postoperative recovery and visual analogue scale (VAS) in appendectomy patients.

METHODS

Forty 15-60-year-old patients at American Society of Anaesthesiologists (ASA) physical status I-II, scheduled for appendectomy were included in the study. After routine monitorisation, anaesthesia induction was performed with propofol, fentanyl and rocuronium; later, maintenance was continued with sevoflurane. Patients were divided into two groups randomly. A total 20 mL of 0.25% (50 mg) levobupivacaine was injected around the incision line as a rectangle in Group 1. Levobupivacaine was not administered in Group 2 patients. Heart rate, peripheral oxygen saturation, additional fentanyl requirement and mean blood pressure were recorded during the operation. All patients were evaluated according to difficulties encountered during extubation.

RESULTS

Discharge time, necessity of diclofenac and postoperative VAS values at 0-1 hours were statistically lower in Group 1 patients than the Group 2 patients (p<0.05). Difficulties, like straining, cough, laryngo-bronchospasm, vomiting and nausea during extubation, were 5% and 25% in Group 1 and Group 2, respectively, but these differences were not statistically significant (p=0.077).

CONCLUSION

Infiltration of 0.25% of levobupivacaine as a rectangle which included the incision line before surgery decreases discharge time, provides analgesia well in the early postoperative period and diminishes the requirement of analgesics in appendectomy patients.

摘要

目的

本研究旨在确定术前 0.25%左旋布比卡因浸润对阑尾切除术患者拔管舒适度、术后恢复及视觉模拟评分(VAS)的影响。

方法

本研究纳入了 40 例年龄在 15 - 60 岁、美国麻醉医师协会(ASA)身体状况为 I - II 级、计划行阑尾切除术的患者。在进行常规监测后,采用丙泊酚、芬太尼和罗库溴铵进行麻醉诱导;随后,用七氟醚维持麻醉。患者被随机分为两组。在第 1 组中,将总共 20 mL 的 0.25%(50 mg)左旋布比卡因以矩形方式注射在切口线周围。第 2 组患者未给予左旋布比卡因。术中记录心率、外周血氧饱和度、额外芬太尼需求量和平均血压。所有患者根据拔管时遇到的困难进行评估。

结果

第 1 组患者的出院时间、双氯芬酸使用必要性以及术后 0 - 1 小时的 VAS 值在统计学上低于第 2 组患者(p<0.05)。拔管时出现的用力、咳嗽、喉 - 支气管痉挛、呕吐和恶心等困难,在第 1 组和第 2 组中分别为 5%和 25%,但这些差异无统计学意义(p = 0.077)。

结论

术前以矩形方式浸润 0.25%左旋布比卡因(包括切口线)可缩短阑尾切除术患者的出院时间,在术后早期提供良好的镇痛效果,并减少镇痛药物的需求。

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本文引用的文献

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Preoperative ropivacaine infiltration in breast surgery.
Acta Anaesthesiol Scand. 2000 Oct;44(9):1093-8. doi: 10.1034/j.1399-6576.2000.440910.x.
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Local wound infiltration with bupivacaine in lumbar laminectomy.
Surg Neurol. 1997 Feb;47(2):120-2; discussion 122-3. doi: 10.1016/s0090-3019(96)00255-8.

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