纳布啡辅助局部浸润麻醉与腰方肌阻滞对结肠癌根治术患者术后镇痛的影响

doi:10.3969/j.issn.1006-6233.2022.02.022

摘要
图/表
参考文献
相关文章 (8)

全文: PDF (1241 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要 目的: 对比纳布啡辅助局部浸润麻醉与腰方肌阻滞用于腹腔镜结肠癌根治术患者的术后镇痛效果。方法: 选取我院2019年7月至2021年4月拟于东南大学附属中大医院溧水分院行腹腔镜结肠癌根治术的患者150例。随机分为局部浸润麻醉组(L组)纳布啡辅助局部浸润麻醉组(N组)和腰方肌阻滞组(Q组),各50例。Q组患者于手术结束后行超声引导下双侧腰方肌阻滞;L组和N组均行切口局部浸润麻醉,L组药物为0.375%罗哌卡因,总量40mL;N组药物为0.375%罗哌卡因+20mg纳布啡混合液,总量40mL。使用NRS评价两组患者安静状态和活动状态下返回病房即刻、术后2h、4h、12h、24h疼痛程度。记录术后24h内PCIA按压次数以及术后恶心呕吐(Postoperative nausea and vomiting,PONV)、术后低血压、头晕、皮肤瘙痒、下肢运动功能阻滞等不良反应发生率。结果: N组、Q组患者术后12h 安静状态下NRS评分均显著低于L组患者,差异有统计学意义(P<0.05),而N组和Q组间术后12h 安静状态下NRS评分的比较差异无统计学意义(P>0.05)。三组患者术后各时点活动状态下NRS评分的比较差异无统计学意义(P>0.05)。L组患者术后24h内PCIA按压次数明显高于N组、Q组患者,差异有统计学意义(P<0.05)。Q组患者下肢运动阻滞发生率显著高于L组和N组患者,差异有统计学意义(P<0.05);N组患者皮肤瘙痒发生率显著低于L组和Q组患者,差异有统计学意义(P<0.05)。结论: 纳布啡辅助局部浸润麻醉能够为腹腔镜结肠癌根治术患者提供与腰方肌阻滞类似的术后镇痛效果及镇痛持续时间,降低皮肤瘙痒发生率且不影响下肢运动功能。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	许建峰
	洪敏
	胡建
	邢凡

关键词 ：腰方肌阻滞, 局部浸润麻醉, 纳布啡, 腹腔镜结肠癌根治术, 术后镇痛

Abstract：Objective: To compare the effect of nalbuphine as an adjuvant to local wound infiltration anesthesia and quadratus lumborum block in patients undergoing laparoscopic radical resection of colon cancer. Methods: A total of 150 patients who planned to undergo laparoscopic radical resection of colon cancer in the Lishui Hospital of Zhongda Hospital affiliated to Southeast University from July 2019 to April 2021 were selected. The patients were randomly assigned to the local wound infiltration anesthesia group (L group), the nalbuphine adjuvant to local wound infiltration anesthesia group (N group) or the quadratus lumbar muscle block group (Q group), 50 patients in each group. Patients in group Q underwent ultrasound-guided bilateral quadratus lumbar muscle block after the operation; group L and group N underwent local infiltration anesthesia of incision, group L had 0.375% ropivacaine, total 40ml; group N had 0.375% ropivacaine + 20mg nalbuphine mixed solution, totally 40ml. NRS was used to evaluate the pain levels of the two groups of patients immediately after returning to the ward in a quiet state and an active state, 2h, 4h, 12h, and 24h after the operation. The number of PCIA compressions within 24 hours after surgery, postoperative nausea and vomiting (PONV), postoperative hypotension, dizziness, skin itching, and lower limb motor function block were recorded. Results: NRS scores in group N and Q at 12h postoperatively quiet state were significantly lower than those in group L, with statistical significance (P<0.05), while there was no statistical significance in NRS scores at 12h postoperatively quiet state between group N and Q (P>0.05). There was no significant difference in NRS scores between the three groups at each time point after operation (P>0.05). The number of PCIA pressing in group L within 24h after surgery was significantly higher than that in group N and Q, with statistical significance (P<0.05). The incidence of lower limb motion block in group Q was significantly higher than that in group L and group N, the difference was statistically significant (P<0.05). The incidence of pruritus in group N was significantly lower than that in group L and Q, with statistical significance (P<0.05). Conclusion: Nalbuphine as an adjuvant to local wound infiltration anesthesia can provide postoperative analgesic effect and duration similar to that of quadratus lumborum block in patients undergoing laparoscopic radical resection of colon cancer, and reduce the incidence of pruritus without affecting the lower limb movement function.

Key words： Quadratus lumborum block Local wound infiltration anesthesia Nalbuphine Laparoscopic radical resection of colon cancer Postoperative analgesia

基金资助:2020年省重点研发计划专项资金,(编号:BE2020723)

引用本文:

许建峰, 洪敏, 胡建, 邢凡. 纳布啡辅助局部浸润麻醉与腰方肌阻滞对结肠癌根治术患者术后镇痛的影响[J]. 河北医学, 2022, 28(2): 287-291.
XU Jianfeng, HONG Min, HU Jian, et al. Effect of Nalbuphine as an Adjuvant to Local Wound Infiltration Anesthesia Versus Quadratus Lumborum Block in Patients Undergoing Laparoscopic Radical Resection of Colon Cancer. HeBei Med, 2022, 28(2): 287-291.

链接本文:

http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2022.02.022 或 http://www.hbyxzzs.cn/CN/Y2022/V28/I2/287

[1] 中华人民共和国国家卫生健康委员会.中国结直肠癌诊疗规范(2020版)[J].中华消化外科杂志,2020,19(6):563~588.
[2] Li Z,Zou Z,Lang Z,et al.Laparoscopic versus open radical resection for transverse colon cancer:evidence from multi-center databases[J].Surg Endosc,2021,35(3):1435~1441.
[3] Feldheiser A,Aziz O,Baldini G,et al.Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery,part 2:consensus statement for anaesthesia practice[J].Acta Anaesthesiol Scand,2016,60(3):289~334.
[4] Elsharkawy H,El-Boghdadly K,Barrington M.Quadratus lumborum block:anatomical concepts,mechanisms,and techniques[J].Anesthesiology,2019,130(2):322~335.
[5] Kim SH,Kim HJ,Kim N,et al.Effectiveness of quadratus lumborum block for postoperative pain:a systematic review and meta-analysis[J].Minerva Anestesiol,2020,86(5):554~564.
[6] Ren YF,Fu X,Wang YT,et al.Nalbuphine versus ketorolac as an adjuvant to local wound Infiltration anesthesia in open colorectal surgery:a prospective randomized controlled study[J].Pain Ther,2021,10(1):551~565.
[7] Lovich-Sapola J,Smith CE,Brandt CP.Postoperative pain control[J].Surg Clin North Am,2015,95(2):301~318.
[8] Wang D,He Y,Chen X,et al.Ultrasound guided lateral quadratus lumborum block enhanced recovery in patients undergoing laparoscopic colorectal surgery[J].Adv Med Sci,2021,66(1):41~45.
[9] Garteiz-Martinez D,Rodriguez-Ayala E,Weber-Sánchez A,et al.Pulmonary recruitment can reduce residual pneumoperitoneum and shoulder pain in conventional laparoscopic procedures:results of a randomized controlled trial[J].Surg Endosc,2021,35(8):4143~4152.
[10] 倪逊,许可,丁婷婷,等.床边超声评估纳布啡联合瑞芬太尼对机械通气患者胃排空功能的影响[J].河北医学,27(5):855~859.
[11] Bai JW,An D,Perlas A,et al.Adjuncts to local anesthetic wound infiltration for postoperative analgesia:a systematic review[J].Reg Anesth Pain Med,2020,45(8):645~655.
[12] Tubog TD,Harenberg JL,Buszta K,et al.Use of nalbuphine for treatment of neuraxial opioid-induced pruritus:a systematic review and meta-analysis[J].AANA,2019,87(3):222~230.
[13] Hirota K,Okawa H,Appadu BL,et al.Interaction of local anaesthetics with recombinant mu,kappa,and delta-opioid receptors expressed in Chinese hamster ovary cells[J].Br Anaesth,2000,85(5):740~746.
[14] Ko MC,Naughton NN,Traynor JR,et al.Orphanin FQ inhibits capsaicin-induced thermal nociception in monkeys by activation of peripheral ORL1 receptors[J].Br Pharmacol,2002,135(4):943~950.