罗哌卡因伤口局部浸润麻醉联合帕瑞昔布镇痛在胰十二指肠切除术患者围术期管理中的效果
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摘要
目的探讨罗哌卡因伤口局部浸润麻醉联合帕瑞昔布多模式镇痛在胰十二指肠切除术患者围术期管理中的效果。方法采取前瞻性随机对照研究,将2017年3月～2018年8月期间四川大学华西医院胆道外科收治的应用罗哌卡因伤口局部浸润麻醉联合帕瑞昔布镇痛的50例胰十二指肠切除患者(试验组)和同期应用地佐辛进行术后镇痛的胰十二指肠切除术患者48例(对照组)的临床资料。两组患者术中麻醉方案一致,术后采用相同的疼痛解救方案;对比分析两组患者围术期NRS疼痛评分,疼痛解救药物使用率,镇痛不良反应发生率,伤口感染发生率、术后首次下床活动时间及术后排气时间等指标的差异。结果分别比较两组患者术后12、24、48、72 h,术后7 d的NRS评分,试验组均低于对照组(P<0.05);试验组的解救镇痛药物使用率低于对照组(32%vs 66.67%,P<0.05);试验组盐酸曲马多使用率低于对照组(P<0.05)。镇痛不良反应方面,试验组患者不良反应总发生率更少(22%vs 54.17%,P<0.05),且恶心、呕吐发生率更低(P<0.05),其余各项不良反应发生率差异无统计学意义(P>0.05),且两组患者伤口感染发生率比较差异无统计学意义(P>0.05);试验组患者术后首次下床活动及首次排气时间早于对照组(P<0.05),且试验组患者术后住院时间更短(P<0.05)。结论罗哌卡因伤口局部浸润麻醉联合帕瑞昔布能有效降低胰十二指肠切除术患者围术期的疼痛程度,减少解救镇痛药物的使用频率,降低不良反应发生率,促进患者术后快速康复。
Objective To explore the effect of local infiltration of ropivacaine combined with multimodal analgesia with parecoxib for perioperative pain management in patients undergoing pancreaticoduodenectomy. Methods 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, n=50) or postoperative analgesia with dizosin(control group, n=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. Results 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(P<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% vs66.67%, P<0.05); the rate of tramadol hydrochloride use was also significantly lower in the experimental group(P<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% vs 54.17%, P<0.05) as well as a lower incidence of nausea and vomiting(P<0.05), an earlier time of first ambulation and first flatus passage after the operation(P<0.05), and a shorter postoperative hospital stay(P<0.05).Conclusion 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.
Objective To explore the effect of local infiltration of ropivacaine combined with multimodal analgesia with parecoxib for perioperative pain management in patients undergoing pancreaticoduodenectomy. Methods 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, n=50) or postoperative analgesia with dizosin(control group, n=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. Results 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(P<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% vs66.67%, P<0.05); the rate of tramadol hydrochloride use was also significantly lower in the experimental group(P<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% vs 54.17%, P<0.05) as well as a lower incidence of nausea and vomiting(P<0.05), an earlier time of first ambulation and first flatus passage after the operation(P<0.05), and a shorter postoperative hospital stay(P<0.05).Conclusion 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.
引文
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[20]李涓,毕艳.罗哌卡因持续切口浸润麻醉对择期行开腹肝癌肝切除术患者镇痛及早期康复的影响[J].解放军医药杂志,2017,29(9):44-7.
[21]Yong L,Guang B.Intraperitoneal ropivacaine instillation versus no intraperitoneal ropivacaine instillation for laparoscopic cholecystectomy:A systematic review and meta-analysis[J].Int J Surg,2017,44(44):229-43.
[22]张波,金岩,巩红,等.3542例患者使用帕瑞昔布术后镇痛情况的多中心、回顾性分析[J].中国药学杂志,2013,48(12):1005-9.
[23]王海燕,许燕玲,胡三莲,等.多模式镇痛方法对跟骨骨折术后患者镇痛效果的影响[J].中国实用护理杂志,2016,32(23):1788-90.
[24]秦新刚,李帆.多模式镇痛复合不同浓度罗哌卡因切口浸润在加速康复外科术后镇痛的效果[J].世界最新医学信息文摘,2017,17(48):82.
[25]Jirarattanaphochai K,Thienthong S,Sriraj W,et al.Effect of parecoxib on postoperative pain after lumbar spine surgery:a bicenter,randomized,double-blinded,placebo-controlled trial[J].Spine(Phila Pa 1976),2008,33(2):132-9.
[26]KyriakidisAV,Perysinakis I,Alexandris I,et al.Parecoxib Sodium in the treatment of postoperative pain after Lichtenstein tension-free mesh inguinal hernia repair[J].Hernia,2011,15(1):59-64.
[27]Akaraviputh T,Leelouhapong C,Lohsiriwat V,et al.Efficacy of perioperative parecoxib injection on postoperative pain relief after laparoscopic cholecystectomy:a prospective,randomized study[J].World J Gastroenter,2009,15(16):2005-8.
[28]Schug SA,Parsons B,Li CM,et al.The safety profile of parecoxib for the treatment of postoperative pain:a pooled analysis of 28randomized,double-blind,placebo-controlled clinical trials and a review of over 10 years of postauthorization data[J].J Pain Res,2017,10(10):2451-9.
[29]Gessner DM,Horn JL,Lowenberg DW.Pain management in the orthopaedic trauma patient:Non-opioid solutions[J].Injury,2019,25(19):4.
[30]Camu F,Borgeat A,Heylen RJ,et al.Parecoxib,propacetamol,and their combination for analgesia after total hip arthroplasty:a randomized non-inferiority trial[J].Acta Anaesthesiol Scand,2017,61(1):99-110.
[31]Akaraviputh T,Leelouhapong C,Lohsiriwat V,et al.Efficacy of perioperative parecoxib injection on postoperative pain relief after laparoscopic cholecystectomy:a prospective,randomized study[J].World Journal of Gastroenterology,2009,15(16):2005-8.
[2]Abu Hilal M,Di Fabio F,Badran AA,et al.Implementation of enhanced recovery programme after pancreatoduodenectomy:Asingle-centre UK pilot study[J].Pancreatology,2013,13(1):58-62.
[3]Braga M,Pecorelli N,Ariotti R,et al.Enhanced recovery after surgery pathway in patients undergoing pancreaticoduodenectomy[J].World J Surg,2014,38(11):2960-6.
[4]Kim SS,Niu X,Elliott IA,et al.Epidural analgesia improves postoperative pain control but impedes early discharge in patients undergoing pancreatic surgery[J].Pancreas,2019,48(5):719-25.
[5]Lee J,Jung SM,Lee Y,et al.Anesthetic management for a patient with bronchobiliary fistula after pancreaticoduodenectomy:A case report[J].Medicine(Baltimore),2019,98(19):e15694.
[6]赖雪莹,汤小伟,黄思霖,等.结肠镜检查过程中疼痛的危险因素分析[J].南方医科大学学报,2017,37(04):482-7.
[7]Angraal S,Nuti SV,Fa MD,et al.Digoxin use and associated adverse EventsAmong older adults[J].Am JMed,2019(19):3.
[8]Wilson SH,Auroux AS,Eloy JD,et al.Ropivacaine 0.1%versus0.2%continuous lumbar plexus nerve blockinfusions following total hip arthroplasty:a randomized,double blinded study[J].Pain Med,2014,15(3):465-72.
[9]Tian X,Yang P,Su T,et al.Intraperitoneal ropivacaine and early postoperative pain and postsurgical outcomes after laparoscopic herniorrhaphy in toddlers:a randomized clinical trial[J].Paediatr Anaesth,2016,26(9):891-8.
[10]Aghvami M,Salimi A,Eshghi P,et al.Targeting the mitochondrial apoptosis pathway by a newly synthesizedCOX-2 inhibitor in pediatric ALL lymphocytes[J].Future Med Chem,2018,10(19):2277-89.
[11]Zhang ZF,Xu HH,Zhang YH,et al.Nonsteroidal anti-inflammatory drugs for postoperative pain control after lumbar spine surgery:Ameta-analysis of randomized controlled trials[J].J Clin Anesth,2017,43(43):84-9.
[12]Nauta M,Landsmeer ML,Koren G.Codeine-acetaminophen versus nonsteroidal anti-inflammatory drugs in the treatment of postabdominal surgery pain:a systematic review of randomized trials[J].Am J Surg,2009,198(2):256-61.
[13]Kroin JS,Ling ZD,Buvanendran A,et al.Upregulation of spinal cyclooxygenase-2 in rats after surgical incision[J].Anesthesiology,2004,100(2):364-9.
[14]李轶聪,刘芳,赵昱.帕瑞昔布钠超前镇痛联合罗哌卡因局部浸润用于腹腔镜胆囊切除术患者术后镇痛的效果[J].中华麻醉学杂志,2012,32(9):1091-3.
[15]陈凛,陈亚进,董海龙,等.加速康复外科中国专家共识及路径管理指南(2018版)[J].中国实用外科杂志,2018,38(1):1-20.
[16]纪雪霞,周国斌,王庆,等.低剂量舒芬太尼联合腹横肌平面阻滞术后镇痛可加速腹腔镜全子宫切除患者的康复[J].南方医科大学学报,2019,39(3):369-72.
[17]Huang JM,Lv ZT,Zhang YN,et al.Efficacy and safety of postoperative pain relief by parecoxib injection after laparoscopic surgeries:a systematic review and meta-analysis of randomized controlled trials[J].Pain Pract,2018,18(5):597-610.
[18]Magee DJ,Jhanji S,Poulogiannis G,et al.Nonsteroidal antiinflammatory drugs and pain in cancer patients:a systematic review and reappraisal of the evidence[J].Br JAnaesth,2019,25(5):20.
[19]Brydone AS,Souvatzoglou R,Abbas M,et al.Ropivacaine plasma levels following high-dose local infiltration analgesia for total knee arthroplasty[J].Anaesthesia,2015,70(7):784-90.
[20]李涓,毕艳.罗哌卡因持续切口浸润麻醉对择期行开腹肝癌肝切除术患者镇痛及早期康复的影响[J].解放军医药杂志,2017,29(9):44-7.
[21]Yong L,Guang B.Intraperitoneal ropivacaine instillation versus no intraperitoneal ropivacaine instillation for laparoscopic cholecystectomy:A systematic review and meta-analysis[J].Int J Surg,2017,44(44):229-43.
[22]张波,金岩,巩红,等.3542例患者使用帕瑞昔布术后镇痛情况的多中心、回顾性分析[J].中国药学杂志,2013,48(12):1005-9.
[23]王海燕,许燕玲,胡三莲,等.多模式镇痛方法对跟骨骨折术后患者镇痛效果的影响[J].中国实用护理杂志,2016,32(23):1788-90.
[24]秦新刚,李帆.多模式镇痛复合不同浓度罗哌卡因切口浸润在加速康复外科术后镇痛的效果[J].世界最新医学信息文摘,2017,17(48):82.
[25]Jirarattanaphochai K,Thienthong S,Sriraj W,et al.Effect of parecoxib on postoperative pain after lumbar spine surgery:a bicenter,randomized,double-blinded,placebo-controlled trial[J].Spine(Phila Pa 1976),2008,33(2):132-9.
[26]KyriakidisAV,Perysinakis I,Alexandris I,et al.Parecoxib Sodium in the treatment of postoperative pain after Lichtenstein tension-free mesh inguinal hernia repair[J].Hernia,2011,15(1):59-64.
[27]Akaraviputh T,Leelouhapong C,Lohsiriwat V,et al.Efficacy of perioperative parecoxib injection on postoperative pain relief after laparoscopic cholecystectomy:a prospective,randomized study[J].World J Gastroenter,2009,15(16):2005-8.
[28]Schug SA,Parsons B,Li CM,et al.The safety profile of parecoxib for the treatment of postoperative pain:a pooled analysis of 28randomized,double-blind,placebo-controlled clinical trials and a review of over 10 years of postauthorization data[J].J Pain Res,2017,10(10):2451-9.
[29]Gessner DM,Horn JL,Lowenberg DW.Pain management in the orthopaedic trauma patient:Non-opioid solutions[J].Injury,2019,25(19):4.
[30]Camu F,Borgeat A,Heylen RJ,et al.Parecoxib,propacetamol,and their combination for analgesia after total hip arthroplasty:a randomized non-inferiority trial[J].Acta Anaesthesiol Scand,2017,61(1):99-110.
[31]Akaraviputh T,Leelouhapong C,Lohsiriwat V,et al.Efficacy of perioperative parecoxib injection on postoperative pain relief after laparoscopic cholecystectomy:a prospective,randomized study[J].World Journal of Gastroenterology,2009,15(16):2005-8.