Feng Jinhua, Li Ka, Feng Huan, Han Qiang, Gao Min, Xu Ruihua
Department of Bilary Surgery of West China Hospital, Sichuan University, Chengdu 610041, China.
West China Nursing College, Sichuan University, Chengdu 610041, China.
Nan Fang Yi Ke Da Xue Xue Bao. 2019 Jul 30;39(7):830-835. doi: 10.12122/j.issn.1673-4254.2019.07.13.
To explore the effect of local infiltration of ropivacaine combined with multimodal analgesia with parecoxib for perioperative pain management in patients undergoing pancreaticoduodenectomy.
This randomized controlled trial was conducted among 98 patients undergoing pancreaticoduodenectomy in the Department of Biliary Surgery of West China Hospital between March, 2017 and August, 2018. The patients were randomized to receive perioperative analgesia with local infiltration anesthesia with ropivacaine combined with multimodal analgesia with parecoxib (experimental group, =50) or postoperative analgesia with dizosin (control group, =48). The regimens for intraoperative anesthesia and postoperative pain relief were identical in the two groups. The differences in NRS pain score, use of pain relief agents, the incidences of adverse reactions to analgesia and wound infection, and the time to first ambulation and first flatus passage after the operation were compared between the two groups.
At 12, 24 h, 48 h, 72 h and 7 days after the operation, the patients in the experimental group had significantly lower NRS scores ( < 0.05) than those in the control group. The rate of use of rescue analgesics was significantly lower in the experimental group than in the control group (32% 66.67%, < 0.05); the rate of tramadol hydrochloride use was also significantly lower in the experimental group ( < 0.05). Compared with those in the control group, the patients in the experimental group showed a significantly lower total incidence of adverse reactions (22% 54.17%, < 0.05) as well as a lower incidence of nausea and vomiting ( < 0.05), an earlier time of first ambulation and first flatus passage after the operation ( < 0.05), and a shorter postoperative hospital stay ( < 0.05).
In patients undergoing pancreaticoduodenectomy, local infiltration of ropivacaine combined with multimodal analgesia with ropivacaine can effectively relieve perioperative pain, reduce the use of relief analgesics, lower the incidence of adverse reactions, and promote the recovery after the surgery.
探讨罗哌卡因局部浸润联合帕瑞昔布多模式镇痛在胰十二指肠切除患者围手术期疼痛管理中的效果。
本随机对照试验于2017年3月至2018年8月在四川大学华西医院胆道外科对98例行胰十二指肠切除术的患者进行。将患者随机分为罗哌卡因局部浸润麻醉联合帕瑞昔布多模式镇痛的围手术期镇痛组（试验组，n = 50）和术后用哌唑嗪镇痛组（对照组，n = 48）。两组术中麻醉及术后疼痛缓解方案相同。比较两组患者的数字分级法（NRS）疼痛评分、镇痛药物使用情况、镇痛不良反应及伤口感染发生率、术后首次下床活动及首次排气时间。
术后12、24、48、72 h及7 d，试验组患者NRS评分显著低于对照组（P < 0.05）。试验组补救性镇痛药物使用率显著低于对照组（32%比66.67%，P < 0.05）；试验组盐酸曲马多使用率也显著较低（P < 0.05）。与对照组相比，试验组患者不良反应总发生率显著较低（22%比54.17%，P < 0.05），恶心呕吐发生率较低（P < 0.05），术后首次下床活动及首次排气时间较早（P < 0.05），术后住院时间较短（P < 0.05）。
在胰十二指肠切除患者中，罗哌卡因局部浸润联合帕瑞昔布多模式镇痛可有效缓解围手术期疼痛，减少镇痛药物使用，降低不良反应发生率，促进术后恢复。
