罗哌卡因与利多卡因运用于会阴侧切缝合术镇痛效果的对比研究

摘要

目的 比较罗哌卡因与利多卡因运用于会阴侧切缝合术中与术后的镇痛效果.方法 选择需行会阴侧切术且无手术禁忌症、无产科并发症、无精神疾患的产妇80例,随机分为实验组和对照组,每组各40例.实验组运用0.375%罗哌卡因20 ml,对照组运用1%利多卡因20 ml,分别在会阴侧切前行阴部神经阻滞麻醉与皮下浸润麻醉.观察比较两组产妇在术中与术后的疼痛程度、麻醉持续时间、新生儿Apgar's评分情况、有无产后尿潴留等不良反应.结果 实验组在缝合术中、用药后1h、2 h、4h、8 h的疼痛VAS评分均低于对照组,F=6.01(P＜0.05),提示实验组在会阴侧切缝合术的镇痛效果与镇痛持续时间明显优于对照组.新生儿1分钟、5分钟的Apgar's评分两组无差别,t=1.863(P＞0.05).未发现对产后出血、尿潴留等不良反应的不良影响.结论 罗哌卡因具有镇痛作用强和持续时间长等优点,效果优于利多卡因.在会阴侧切术中应用小剂量罗哌卡因行会阴部神经阻滞麻醉与皮下浸润麻醉,有效减轻产妇在产时和产后的切口疼痛,为产妇创造一个良好的康复条件.%Objective To compare the analgesic effect of ropivacaine and lidocaine during and after lateral episiotomy perineorrhaphy. Methods 80 mental well pregnant women who needed to have the lateral episiotomy perineorrhaphy were selected as our participants, they were all without surgical contraindications and obstetric complications. Then they were randomly divided into 2 groups, the experimental and the control group, and each group consisted 40 participants. Before the episiotomy, the experimental group was applied with 0.375% ropivacaine 20ml, the control group was applied with 1% lidocaine 20ml respectively to achieve perineal nerve block anesthesia and subcutaneous infiltration anesthesia. In the study we not only compared the pain level and the analgesia time between the 2 groups and also evaluated the Apgar score, the postpartum urinary retention and other adverse reactions between them. Results The VAS score of the experimental group is lower than that in the control group during and after the analgesic was administrated 1 hour, 2 hours, 4 hours and 8 hours, F=6.01( P＜0.05 ). It reminds us that not only the analgesic effect but also the analgesia time of ropivacaine is better than the lidocaine, however, the Apgar's 1 minute's and 5 minute's score were non-significant between the 2 groups, t=1.863 ( P＞ 0.05 ), and the adverse effects such as Postpartum hemorrhage and Urinary retention were also non-significant between the 2 groups .Conclusion Compared with lidocaine, ropivacaine's analgesic effect is much stronger and it's analgesic time is much longer. When we apply the lateral episiotomy perineorrhaphy, we use low-dose ropivacaine instead of lidocaine to achieve the goal of perineal subcutaneous infiltration anesthesia and nerve block anesthesia, we can relieve the Incision pain during and after the operation effectively at the same time providing a better recovery premise for the pregnant women.