张超　 谢宗平　金东旭　 张长青

200233，　　上海交通大学附属第六人民医院骨科



罗哌卡因联合地塞米松局部浸润改善骨与关节手术后镇痛效果

张超 谢宗平金东旭 张长青

200233，上海交通大学附属第六人民医院骨科

【摘要】目的探讨罗哌卡因联合地塞米松手术区域局部浸润镇痛能否改善骨与关节手术后疼痛及减少术后口服镇痛药量。 方法将2014年6月至8月我院51例需行骨关节手术患者随机分成两组，实验组术中局部浸润0.1%罗哌卡因20 mL(200 mg)联合地塞米松2 mg,对照组术中局部浸润等量生理盐水。记录患者术后4、8、12、24、48 h疼痛视觉模拟评分(VAS),给予自觉疼痛难忍者口服镇痛药。主要评价指标为术后VAS评分；次要评价指标为口服镇痛药物剂量及首次口服镇痛药物距手术结束时间、术后不良反应、总体满意度等。结果实验组与对照组术后8、12、24、48 h VAS评分有统计学差异，两组口服奇曼丁总剂量、总体满意度有统计学差异。结论罗哌卡因联合地塞米松手术区域局部浸润可显著降低骨与关节手术后静息疼痛，减少需使用镇痛药物的人数，延迟术后镇痛药物应用时间，减少镇药物使用剂量。

【关键词】骨与关节手术；麻醉；镇痛；局部浸润

The analgesic effect of intraoperative wound infiltration with ropivacaine and dexamethasone after bone and joint surgeryZHANGChao,XIEZong-ping,JINDong-xu,ZHANGChang-qing.

Departmentoforthopaedics,theSixthPeople’sHospitalAffiliatedtoShanghaiJiaotongUniversity,Shanghai200233,China

Correspondingauthor:ZHANGChang-qingE-mail:zhangcq6th@gmail.com

【Abstract】ObjectiveTo evaluate the analgesic effect of intraoperative wound infiltration with ropivacaine and dexamethasone after bone and joint surgery. Methods From June to August 2014, 51 patients were randomized into two groups. At the end of suegery, 20 mL 0.1% ropivacaine (200 mg) and dexamethasone (2 mg) or saline was respectively infiltrated in two groups. The visual analog scales (VAS) scores at 4,8,12,24 and 48 h after surgery were recorded, and the patients were administered with analgesics if the patients thought the pain had a negative effect on rest. The primary endpoints were the VAS scores at 4，8，12，24 and 48 h. The secondary endpoints were total dose of analgesics, time of analgesics consumption, side-effects and gross satisfaction scales. Results The VAS scores at 8,12,24 and 48 h after surgery while resting, total dose of analgesics, time of analgesics consumption, side-effects and gross satisfaction scales were statistically different between two groups. Conclusion Ropivacaine and dexamethasone wound infiltration could reduce postoperative pain and analgesics requirements during the first 48 hours after surgery.

【Key words】Bone and joint surgery; Anesthesia; Analgesia; Local infiltration

骨与关节手术患者术后常出现中至重度疼痛[1]，合理有效的术后镇痛可减轻疼痛并缩短患者住院时间。传统术后镇痛方式为：经静脉自控镇痛，硬膜外自控镇痛，外周神经区域阻滞镇痛，口服或静脉、肌肉注射非甾体类抗炎药或阿片类药物阵痛。然而，这些镇痛方式往往会引起恶心、呕吐、尿潴留、肢体运动阻滞等不良反应[2-4]。……