【摘要】 目的 评估罗哌卡因切口预注射联合曲马多对腹腔镜下胆囊切除术（laparoscopic cholecystectomy，LC）术后疼痛的影响。 方法 选取2010年6月-2011年4月行择期LC患者120例，年龄18~65岁，美国麻醉师协会Ⅰ~Ⅱ级，采用完全随机的设计分组：0.75%罗哌卡因10 mL切口注射+术毕静脉注射曲马多（2 mg/kg）组（A组，n=30）；生理盐水10 mL切口注射+术毕静脉注射曲马多（2 mg/kg）组（B组，n=30）；0.75%罗哌卡因10 mL切口注射+术毕静脉注射生理盐水10 mL组（C组，n=30）；生理盐水组（D组，n=30）。术后2、4、6、12、24 h分别评估右上腹部、右肩背部和腹壁切口疼痛进行视觉模拟评分（visual analog scale，VAS）。 结果 右上腹部及右肩背部疼痛VAS比较：与D组相比，A、B组VAS评分明显减少（Plt;0.05），而C组无明显统计学差异（Pgt;0.05）；B组与A组相比，2~24 h VAS评分明显增加（Plt;0.05）；C组与A组相比，2~24 h VAS评分增高（Plt;0.01）。腹壁切口疼痛VAS比较:与D组相比，A、B、C组VAS评分明显减少（Plt;0.05）；B组与A组相比，2~24 h VAS评分明显增加（Plt;0.05）；C组与A组相比，2~24 h VAS评分显著增高（Plt;0.01）。 结论 腹腔镜胆囊切除术术前切口罗哌卡因预注射-术毕曲马多静脉注射对减轻术后疼痛有良好效果。【Abstract】 Objective To evaluate the effects of preincisional ropivacaine plus tramadol intravenous injection on postoperative pain relief after laparoscopic cholecystectomy (LC). Methods One hundred and twenty patients aged between 18 and 65 years old with an ASA score from Ⅰ to Ⅱ who underwent elective laparoscopic cholecystectomy from June 2010 to April 2011 comprised this study. The patients were randomly divided into four groups with 30 in each group. Patients in group A had an infusion of 0.75% ropivacaine (10 mL) at the beginning of LC plus tramadol (2 mg/kg) intravenous injection at the end. Group B patients had an infusion of normal saline 0.9% (10 mL) at the beginning of LC plus tramadol (2 mg/kg) intravenous injection at the end. Patients in group C had an infusion of 0.75% ropivacaine (10 mL) at the beginning of LC plus normal saline 0.9% (10 mL) intravenous injection at the end. Group D (control group) patients had neither ropivacaine nor tramadol infusion. Pain in the right upper abdomen, right shoulder tip and abdominal incision were assessed at hour 2, 4, 6, 12, and 24 postoperatively using a visual analog score (VAS). Results Right upper abdomen and right shoulder tip pain VAS comparison: significantly lower pain scores were observed in group A and B (Plt;0.05) than in group D (Pgt;0.05). Group A had significantly lower pain scores than group B (Plt;0.05) and C (Plt;0.01) at postoperative hours 2, 4, 6, 12, and 24. Abdominal incision pain VAS comparison: VAS scores were significantly lower in group A, B and C than in group D (Plt;0.05). Group A had significantly lower pain scores than group B (Plt;0.05) and C (Plt;0.01) at postoperative hours 2, 4, 6, 12, and 24. Conclusion Preincisional ropivacaine at the beginning of LC combined with tramadol intravenous injection at the end can effectively alleviate postoperative pain after laparoscopic cholecystectomy.
【摘要】 目的 通过不同方式静脉滴注曲马多用于腹腔镜胆囊切除术以评价其镇痛作用。 方法 2007年8月-2009年8月择期行腹腔镜胆囊切除术患者90例，ASAⅠ或Ⅱ级，随机分成A、B、C、D组，在全身麻醉诱导后和手术结束时两个时间点分别给予曲马多2.5 mg/kg或生理盐水，A组曲马多，生理盐水；B组生理盐水，曲马多；C 组曲马多；D组生理盐水。分别于手术后2、4、8、24 h进行视觉模拟评分法（VAS）评分，了解不良反应的发生情况及镇痛药的使用情况。 结果 手术后2、4、8、24 h，A、B、C组VAS评分低于D组（Plt;0.05）；手术后8 h，A、C组明显低于B、D组（Plt;0.05）。 结论 曲马多2.5 mg/kg预注用于腹腔镜胆囊切除术的超前镇痛是可行而有效的。【Abstract】 Objective To evaluate the analgesic effect of intravenous tramadol in laparoscopic cholecystectomy through different ways. Methods Ninety patients of elective laparoscopic cholecystectomy (ASA Ⅰ or Ⅱ) from August 2007 to August 2008 were randomly divided into group A, B, C, and D, which were given Tramadol (2.5 mg/kg) or normal saline after the induction of general anesthesia and end of surgery. Group A: first tramadol then normal saline, group B: first saline then tramadol; group C: only given tramadol; group D: only given normal saline, respectively give VAS scores two, four, eight and 24 hours after surgery to understand the occurrence of adverse reactions and the use of analgesic drugs. Results The VAS scores two, four, eight and 24 hours after surgery, the scores of group A, B and C were lower than that of group D (Plt;0.05), VAS scores eight hours after surgery of group A and C were lower than that of group B and D (Plt;0.05). Conclusions The tramadol (2.5 mg/kg) pre-injection for analgesia of laparoscopic cholecystectomy is feasible and effective analgesia.
目的:探讨同哌替啶和曲马多比较,格拉斯琼预防全麻后寒战的临床效果。方法:120例ASA I～II级,在全麻下拟行择期手术患者,随机分为四组,每组30例:T组(曲马多1mg/kg),G组(格拉斯琼40 μg/kg),M组(哌替啶0.4mg/kg)和P组(0.9%生理盐水)。各组药物在手术结束时通过静脉给予。记录术后寒战评分和麻醉恢复时间及镇静程度。结果:同对照组比较,格拉斯琼明显减少麻醉后寒战的发生(Plt;0.01),但同哌替啶和曲马多组比较无统计学差异(Pgt;0.05)。哌替啶组和曲马多组的麻醉恢复时间(20.58±3.56和16.45±4.13 min)较对照组(12.61±3.31 min)和格拉斯琼组(13.58±3.41 min)明显延长(Plt;0.05)。结论:使用40 μg/kg格拉司琼同使用曲马多1mg/kg和哌替啶0.4mg/kg一样可有效地预防麻醉后寒战。
ObjectiveTo compare the effect of pretreatment with butorphanol or tramadol for prevention of propofol-induced injection pain by intravenous injection or drip, in order to explore a safe and effective method. MethodsWe chose 150 patients of ASAⅠ-Ⅱundergoing elective surgery between October 2012 and March 2013 in Sichuan Orthopedic Hospital as the study subjects. They were randomly divided into five groups with 30 patients in each group:butorphanol injection and drip group (group BI and group BD), tramadol injection and drip group (group TI and group TD), control group (group C). Five minutes before anesthesia induction, patients in group BI, TI and C were respectively injected with butorphanol 2 mg, tramadol 100 mg, and saline; patients in group BD and TD were respectively injected with butorphanol 2 mg and tramadol 100 mg before receiving propofol (2.5 mg/kg) for 2 minutes. Assessment of pain during injection was done by using a four-point scale. ResultsThe pre-injection pain incidence in group BI and TI was significantly higher than that in group BD, TD and C(P < 0.05), and it was significantly higher in group BI than group TI (P < 0.05). The incidence of propofol injection pain in group BI, BD, TI and TD were significantly lower than that in group C (P < 0.05), and it was the lowest in group BD (P < 0.05) followed by group BI (P < 0.05). The total rate of pain in group BD was only 6.67%, significantly lower than other groups (P < 0.05). ConclusionsThe pretreatment with butorphanol and tramadol by intravenous injection or drip can reduce the incidence of propofol injection pain. Pretreatment with butorphanol at 2 mg by intravenous drip is more effective, but should be closely observed to avoid adverse events.
【摘要】 目的 观察曲马多超前镇痛对经腹子宫切除术患者术后疼痛和恶心呕吐的影响。 方法 2008年11月-2009年5月，40例全身麻醉下行经腹子宫切除术的患者，分为超前镇痛组和对照组（n=20）。超前镇痛组和对照组于麻醉诱导前30 min分别静脉注射曲马多（3 mg/kg）和生理盐水。术后12、24 h，观察Bolus次数和芬太尼的用量，患者疼痛评分及术后恶心呕吐的发生率。 结果 术后12、24 h，曲马多超前镇痛组Bolus次数和芬太尼的用量均小于对照组（Plt;0.05），术后恶心呕吐的发生率差异无统计学意义（Pgt;0.05）。 结论 经腹子宫切除术手术前给予曲马多超前镇痛能够减少术后镇痛药的需要量，且不增加术后恶心呕吐的发生率。【Abstract】 Objective To observe the effects of tramadonl preemptive analgesia on postoperative pain and postoperative nausea and vomiting (PONV) in patients with hysterectomy. Methods Form November 2008 to May 2009, fourty patients who had undergone hysterectomy were divided into preemptive analgesia (PA) group and control group, 20 patients in each. The PA and control group were intravenously injected with tramadol (3 mg/kg) and normal saline respectively. Twelve and 24 hours after hysterectomy, the Bolus times, consumption of fentanil, pain score and incidence of PONV were observed. Results Twelve and 24 hours after hysterectomy, the Bolus times and consumption of fentanil were both lower than those in control group(Plt;0.05), the difference of PONV incidences between two groups was not statistically significant (Pgt;0.05). Conclusion Intravenously injected with tramadol before hysterectomy can recduce the dosage of analgesic, and don′t increase the incidence of PONV.
目的:探讨同哌替啶和曲马多比较,格拉斯琼预防全麻后寒战的临床效果。方法:120例ASA I～II级,在全麻下拟行择期手术患者,随机分为四组,每组30例:T组(曲马多1 mg/kg),G组(格拉斯琼40 μg/kg),M组(哌替啶0.4 mg/kg)和P组(0.9%生理盐水)。各组药物在手术结束时通过静脉给予。记录术后寒战评分和麻醉恢复时间及镇静程度。结果:同对照组比较,格拉斯琼明显减少麻醉后寒战的发生(P＜0.01),但同哌替啶和曲马多组比较无统计学差异(P ＞0.05)。哌替啶组和曲马多组的麻醉恢复时间(20.58±3.56和16.45 ±4.13 min)较对照组(12.61 ± 3.31 min)和格拉斯琼组(13.58 ± 3.41 min)明显延长(P＜0.05)。结论:使用40 μg/kg格拉司琼同使用曲马多1 mg/kg和哌替啶0.4 mg/kg一样可有效地预防麻醉后寒战。
【摘要】 目的 观察帕瑞昔布钠超前镇痛在小儿上肢骨折手术的镇痛效果及不良反应发生情况。 方法 选择2009年6月－2010年12月气管插管全身麻醉下择期行单侧上肢骨折切开复位内固定手术患儿90例，随机分为帕瑞昔布钠组（P组）、曲马多组（T组）及对照组（C组），每组各30例患儿；于麻醉前分别静脉注射帕瑞昔布钠1 mg/kg、曲马多2 mg/kg、等容量生理盐水。3组患儿年龄、性别、体重、手术时间等一般情况差异无统计学意义（Pgt;0.05）。各组均于术后2、4、6、8 h各时间点观察患儿疼痛评分、镇静评分；观察拔除患儿气管导管后5 min躁动评分；记录患儿术中芬太尼总用量及术后镇痛药物用量；随访术后24 h内不良反应的发生情况。 结果 术后各个时间点P组疼痛评分明显低于T、C组（Plt;0.01）；T组镇静评分于术后2、4、6 h明显高于P、C组（Plt;0.01），镇静评分在P、C组之间比较差异无统计学意义（Pgt;0.05）；P组术后躁动评分明显低于T、C组（Plt;0.01）；P组患儿围手术期芬太尼用量明显少于T、C组（Plt;0.01）；T组术后恶心呕吐发生率明显高于P、C组（Plt;0.05）。P组无呼吸抑制、伤口异常出血等严重不良反应。 结论 帕瑞昔布钠超前镇痛用于小儿上肢骨折手术可产生明显镇痛作用，并可有效预防苏醒期躁动发生，明显减少围手术期芬太尼用量，恶心呕吐等不良反应发生率明显低于曲马多。【Abstract】 Objective To study the efficacy and safety of preemptive analgesia with parecoxib sodium in children undergoing upper limb orthopedic surgery. Methods Ninety children from June 2009 to December 2010 scheduled for elective upper limb orthopedic surgery under general anesthesia were selected and randomly divided into three groups with 30 children in each. For the children in group P (parecoxib sodium), group T (tramadol) and group C (control), preemptive analgesia was induced by an intravenous injection of parecoxib sodium at 1 mg/kg, tramadol at 2 mg/kg, and normal saline respectively before anesthesia. Pain intensity score and sedation score were recorded 2, 4, 6, and 8 hours respectively after operation. The agitation score was measured 5 minutes after extubation. The perioperative fentanyl consumption and postoperative analgesic medicine consumption were recorded. The adverse effects were observed within 24 hours after operation. Results The demographic data such as age, gender, weight, and operation time did not differ statistically among the three groups of children (Pgt;0.05). Compared with groups T and C, the pain score in group P was significantly lower at all time points after operation (Plt;0.01). The sedation score in group T was significantly higher than those in group P and C 2, 4, and 6 hours after operation (Plt;0.01), but the sedation score did not differ significantly between groups P and C (Pgt;0.05). The agitation score after trachea extubation in group P was significantly lower than the other two groups (Plt;0.01). The quantity of fentanyl used in group P was significantly lower than in groups T and C (Plt;0.01). The incidence of postoperative nausea or vomiting in group T was higher than those in groups P and C (Plt;0.05). There was no depression of breath or abnormal hemorrhage in group P. Conclusion Parecoxib sodium has a better analgesic effect in children undergoing upper limb orthopedic surgery. The agitation score and the incidence of postoperative nausea or vomiting are significantly lower, and the use of parecoxib sodium can also significantly reduce the perioperative fentanyl consumption.