【摘要】 目的 評估羅哌卡因切口預注射聯合曲馬多對腹腔鏡下膽囊切除術（laparoscopic cholecystectomy，LC）術后疼痛的影響。 方法 選取2010年6月-2011年4月行擇期LC患者120例，年齡18~65歲，美國麻醉師協會Ⅰ~Ⅱ級，采用完全隨機的設計分組：0.75%羅哌卡因10 mL切口注射+術畢靜脈注射曲馬多（2 mg/kg）組（A組，n=30）；生理鹽水10 mL切口注射+術畢靜脈注射曲馬多（2 mg/kg）組（B組，n=30）；0.75%羅哌卡因10 mL切口注射+術畢靜脈注射生理鹽水10 mL組（C組，n=30）；生理鹽水組（D組，n=30）。術后2、4、6、12、24 h分別評估右上腹部、右肩背部和腹壁切口疼痛進行視覺模擬評分（visual analog scale，VAS）。 結果 右上腹部及右肩背部疼痛VAS比較：與D組相比，A、B組VAS評分明顯減少（Plt;0.05），而C組無明顯統計學差異（Pgt;0.05）；B組與A組相比，2~24 h VAS評分明顯增加（Plt;0.05）；C組與A組相比，2~24 h VAS評分增高（Plt;0.01）。腹壁切口疼痛VAS比較:與D組相比，A、B、C組VAS評分明顯減少（Plt;0.05）；B組與A組相比，2~24 h VAS評分明顯增加（Plt;0.05）；C組與A組相比，2~24 h VAS評分顯著增高（Plt;0.01）。 結論 腹腔鏡膽囊切除術術前切口羅哌卡因預注射-術畢曲馬多靜脈注射對減輕術后疼痛有良好效果。【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.
目的 探討鹽酸氨基葡萄糖膠囊聯合透明質酸鈉注射液治療髖骨關節炎的臨床療效。 方法 納入疼痛門診2010年7月－2011年7月收治的髖骨關節炎患者60例，隨機分為透明質酸鈉關節腔內注射聯合口服鹽酸氨基葡萄糖膠囊組（A組）和單獨透明質酸鈉關節腔內注射組（B組），每組30例。透明質酸鈉關節腔內注射均為2.5 mL/次，每周1次，連續5周為1療程。鹽酸氨基葡萄糖膠囊口服，0.75 g/次，2次/d，6周為1個療程。評估兩組患者治療后6周后髖關節疼痛視覺模擬評分（VAS評分）及Lequesne指數評定髖關節休息痛、運動痛、局部壓痛、關節活動度、晨僵及行走能力，并觀察兩組不良反應發生情況。 結果 治療6周后A組Lequesne功能指數及VAS評分較B組顯著降低（P＜0.05），兩組不良反應比較差異無統計學意義（P＞0.05）。 結論 治療髖骨關節炎患者時，聯合應用透明質酸鈉及鹽酸氨基葡萄糖膠囊療效優于單獨應用透明質酸鈉者，且并未增加不良反應的發生。
Objective To investigate whether the peri pheral administration of amitri ptyl ine and bupivacaine produces anti-hyperalgesic effect and to screen the neurotoxicological effect on sciatic nerve blockade in a rat model of neuropathic pain. Methods Twenty-four adult male SD rats [weighing (200 ± 20) g] were made the models of chronic constriction injury (CCI) and randomly divided into 3 groups (n=8) 5 days after operation: group A (amitriptyl ine), group B (bupivacaine) and group C (normal sal ine). 0.5 mL 0.5% amitriptyl ine, 0.5% bupivacaine or normal sal ine were given in group A, group B, and group C, respectively through implanted cannulas after 5, 7 and 9 days of CCI once a day for successive 3 days. The motor function was measured before administration and 1, 2, 4, 8, 12 and 24 hours after every administration. Mechanical withdrawal threshold (MWT) and thermal withdrawal latency (TWL) were measured before administration and 1, 3, 5 and 7 days after the third administration. The operated sciatic nerve samples were obtained for neuropathological examination under l ight microscope. Results Twenty-four CCI rats were all survival without infection, palsy and catheter fall ing off. Compared with group C, the rats of group A and group B both produced significant ambulation deficits after every administration (P lt; 0.05). The ambulation deficits lasted 2 hours (group B) and 8 hours (group A) respectively. But the ambulation deficits of CCI rats were all reversible. The MWT and TWL of group A 1 and 3 days after the third administration increased when compared with those before administration and 5 and 7 days after the third administration, and when compared with group B and group C (P lt; 0.05). There was no significant difference (P gt; 0.05) in l ight microscopic neuropathological examination among three groups. Epineurial tissue and endoneurium tissue integrity, tidy arrangement of fibers, less inflammatory cell and no marked degeneration of myel inated fibers were observed. Conclusion Repeated sciatic nerve blockade with 0.5% amitriptyl ine has peripheral anti-hyperalgesic effects on neuropathic pain of rats. No morphological evidence of neurotoxicity in the sciatic nerve of rats is observed in 0.5% amitriptyl ine.