| Objective:Due to small injury,less bleeding,shorter operation time,rapid postoperative recovery and beautiful incision,laparoscopic surgery in recent decades has been developed rapidly.Laparoscopic surgery is minimally invasive surgery,but surgery-induced pain is still the problem unable to avoid after surgery.Paraxibuna is a new nonsteroidal anti-inflammatory analgesic agent,while ropivacaine is a class of long-acting amide local anesthetics.They both are clinically common analgesic drugs,but study on the combination of paraxibuna and ropivacaine in gynecology laparoscopic surgery is rare.In this study,we intend to study the effect of ropivacaine and parecoxibine alone or in combination on the analgesic management of gynecologic laparoscopic surgery,including analgesic effect,adverse reaction,inflammation control,which would provide reference for clinical anesthesia.Methods:A total of 60 patients underwent elective laparoscopic hysterectomy due to gynecological benign lesions were selected in our hospital from January 2015 to December 2015.The patients were randomly divided into P group,L group,M group and placebo group.Each group had 15 patients.P group were treated with parecoopine independently,L group were treated with ropivacaine local analgesic analgesia,M group were treated with the combination of parecoopine and ropivacaine,placebo group did not use any analgesic.The operation time,anesthesia time,bleeding volume,anesthesia recovery index,anesthetic dosage and basic vital signs were recorded.Visual analogue scales(VAS),face pain scale-revised(FPS-R),Ramsay sedation score(RSS)and postoperative nausea and vomiting(PONV)score were conducted.At the same time the recovery of exhaust,nausea,vomiting,skin itching,chest tightness,dizziness and other adverse reactions occurred,the detection of plasma CRP levels,and the results were recorded and analyzed.Results:1.The operation time in P group,L group,M group and placebo group was(79±18)min,(82±20)min,(85±17)min and(83±16)min respectively.The anesthesia time was(88±19)min,(93±23)min,(96±25)min and(92±21)min.The intraoperative blood loss was(64±13)ml,(62±14)ml,(66±11)ml and(65±16)ml.There was no significant difference in the operation time,anesthesia time and blood loss between the four groups(P>0.05).2.The postoperative respiratory recovery time were(11.9±3.1)min,(11.5±3.2)min,(11.1±2.9)min and(12.1±2.8)min respectively in 4 groups.The awake time were(13.4±1.6)min,(13.2±1.7)min,(12.6±1.5)min and(13.7±1.6)min in 4 groups.Extubation time were(13.1±1.4)min,(13.2±1.5)min,(11.8±1.4)min and(13.8±1.8)min in 4 groups.And the first exhaust time were(1.7±2.5)hr,(20.8±2.4)hr,(17.2±2.2)hr and(21.8±2.7)hr,respectively.The extubation time and the first exhaust time of M group were significantly shorter than that in the other three groups(P<0.05).Propofol and fentanyl dosage of M group were 6.9±0.8 mg/(kgxhr)and 10.8±1.5 ?g/(kgxhr),which was significantly less than the other three groups(P<0.05).The propofol and fentanyl dosage of P group and L group were significantly lower than that of the placebo group(P<0.05),but there was no significant difference between P group and L group(P>0.05).3.There were no significant difference in mean arterial pressure,heart rate and respiratory rate between the 4 groups at 0 hr,6 hr,12 hr,24 hr and 48 hr after operation by basic vital signs monitoring(P>0.05).4.VAS score and FPS-R scores showed that as the time goes by the postoperative pain was gradually relieved in 4 groups.Surgical incision pain has the highest degree,followed by abdominal pain and shoulder pain(P<0.05).The pain level of M group of patients at each time point was lower than of the other 3 groups.The pain level of P group and the L group was significantly lower than that of the placebo group(P<0.05),but there was no significant difference between the two groups(P>0.05).5.Ramsay(R55)sedation showed no statistically significant difference in sedation between each groups(P>0.05).6.The incidence of malignant vomiting was significantly higher in M group than in the other 3 groups(P<0.05).The incidence of malignant vomiting in P group and L group was significantly lower than that in the placebo group,but there was no significant difference between P and L group(P>0.05).7.The main adverse events were nausea and vomiting.The incidence of nausea and vomiting was significantly lower in M group than that in the other 3 groups(P<0.05),and there was no between P group,L group and placebo group(P>0.05).8.The serum CRP level in P group,L group and M group were significantly lower than those in placebo group(P<0.05).The serum CRP level in M group was significantly lower than that of P group and L group,but the serum CRP level in P group and L group had no significant difference(P>0.05).Conclusions:1.Ropivacaine-Parecoopine multi-model analgesia can be safely used for laparoscopic gynecological surgery.2.Ropivacaine-Parecroopine multi-model analgesia is better than analgesic using a single drug alone.It decreases the dosage of propofol and fentanyl,reduces the incidence of nausea,vomiting and some other adverse reactions.Besides,it is more effective in controlling inflammation,faster the recovery of patients after surgery,and meets high anesthesia satisfaction. |
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