| Objective:To explore the analgesic effect of incision infiltrated with ropivacaine combined with pentazocine after thoracoscopic lobectomy,and to provide insight for effective postoperative analgesia in thoracic surgery.Method:During the study period(December 2018 to May 2019),90 patients aging from 41 to 75 years,weight 40-93 kg,education level ≥ 5 years,51 males and 39 females,with an American Society of Anesthesiologists(ASA)physical status II–III,who was scheduled for thoracoscopic pulmonary lobectomy at the Affiliated Hospital of Qingdao University were enrolled in the study.The surgeons in the same group completed the operation.The local ethics committee approved the study protocol.Patients randomly divided into control group(Group D),ropivacaine group(Group L),ropivacaine combined with pentazocine group(Group E),30 in each group.At the end of surgery,Group D,no special treatment;Group L,20 ml of 0.5% ropivacaine was used for local infiltration around the incision skin and muscle and the drainage tube;Group E,the mixture of 0.5%ropivacaine and 30 mg pentazocine was used for local infiltration around the incision skin and muscle and the drainage tube;and three groups all received Patient Controlled Intravenous Analgesia(PCIA).Postoperative recovery of the three groups(recovery time,extubation time,occurrence rate of agitation in the recovery period and score of agitation)was compared.Visual analogue scale(VAS)were measured at rest and cough at 4,8,12,24 and 48 hours after surgery.The effective number of PCIA compressions and the cumulative amount of analgesic drug(sufentanil)were recorded 48 hours after the operation.The time of the first artificial anal exhaust and get out of bed after operation,incidences of postoperative complications and the average duration of hospitalization were observed.Result:(1)There was no statistically significant difference in postoperative recovery time and extubation time between the three groups(P > 0.05).Compared with the occurrence rate and score of agitation in the recovery period of the three groups,Group E and Group L were significantly lower than group D(P < 0.05),and there was no statistically significant difference between Group E and Group L.(2)At 4,8,12 hours after operation,VAS scores at rest and cough was lower in Group E than Group L and group D,and Group L were lower than Group D(P<0.05).VAS scores at the 24 th hour after operation,Group E was significantly lower than Group L and group D(P < 0.05),and there was no statistically significant difference between Group D and Group L.There was no statistically significant difference in VAS scores between the three groups at rest and cough at 48 h after surgery.Comparison of the three groups.(3)The effective number of PCIA compressions and the accumulative amount of analgesics in group E 48 hours after the operation were lower than those in group L and group D,and group L is less than group D(P < 0.05).(4)The first time of anal exhaust,the first time of getting out of bed and the days of hospitalization in Group E were shorter than those in group L and D,and group L is less than group D(P < 0.05).(5)There was no significant difference in the incidence of postoperative complications among the three groups(P > 0.05).(6)The incidence of nausea and vomiting was 3.33% in Group E and l,which was lower than 20.00% in group D(P < 0.05),there was no significant difference in other adverse reactions(P > 0.05).Conclusion:The application of incision infiltration anesthesia in thoracoscopic pulmonary lobectomy can significantly reduce postoperative pain,especially using ropivacaine combined with pentazocine.It can play a synergistic analgesic role with prolonging the action time,reducing postoperative restlessness 、 the dosage of intravenous analgesics and the incidence of postoperative nausea and vomiting which can accelerate the recovery of patients,and it is simple and easy to implement.As a part of multimodal analgesia,it is worthy of clinical application. |
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