【摘要】 目的 觀察小劑量氯胺酮在健忘鎮痛麻醉輔助局部麻醉（局麻）剖宮產中的應用。方法 選擇1200例剖宮產的孕婦,隨機分為單純局麻組(L組)、氟芬強化局麻組(F組)和健忘鎮痛麻醉組(J組),每組400例。L組單純局麻;F組局麻術中輔以氟哌利多500 mg,芬太尼015 mg;J組在F組基礎上輔以氯胺酮,觀察各組患者麻醉誘導至胎兒娩出時間;新生兒1、5 min Apgar評分;手術中血壓相對于基礎值的波動情況;手術中及手術后出血情況及麻醉滿意度。 結果 J組與L組和F組比較,胎兒娩出時間無顯著差別;Apgar評分提高;手術中孕婦血壓波動不明顯;手術中及手術后出血量無明顯增加,麻醉滿意度明顯提高。 結論 由小劑量氯胺酮輔助實施的健忘鎮痛麻醉在局麻剖宮產中優于單純局麻和氟芬強化局麻,在剖宮產中尤其急診剖宮產中值得推廣。【Abstract】 Objective To observe the application of lowdose ketamine during the local anesthesia in cesarean section assisted by analgestic and amnestic anesthesia. Methods A total of 1200 cases who need cesarean section were randomly divided into 3 groups (400 cases in each group): simple local anesthesia group (group L), droperidolfentanyl strengthen local anesthesia group (group F) and analgestic and amnestic anesthesia group (group J). Group L was only local anesthesia. Group F was local anesthesia supplemented by droperidol 500 mg, fentanyl 015 mg. Group J was supplemented with ketamine on the basis of group F. Then the time from anesthesia to the fetus delivery, Neonatal Apgar score of one and five minutes, the blood pressure fluctuations, amount of bleeding in or after surgery and the satisfaction of anesthesia were all observed. Results Compared with group L and F, the delivery time was no significant difference, Apgar score increased, blood pressure fluctuations in pregnant women was not obviously varied, amount of bleeding in or after surgery had no significantly increase, and the satisfaction of anesthesia improved markedly all in group J. Conclusions The analgestic and amnestic anesthesia assisted by lowdose ketamine, in cesarean section, is better than local anesthesia and strengthen local anesthesia by droperidolfentanyl, which is worthy to be popularized, especially in emergency caesarean section.
Objective To evaluate the analgesic effect of intra-articular ropivacaine with lidocaine. Methods A double-blind randomized controlled trial was conducted. Ninety patients receiving selective knee arthroscopy were randomized into three groups of 30 patients. At the end of the operation, before the release of the tourniquet, an intra-articular injection was administered to each patient through arthroscope, in accordance with their random allocation: 0.9% normal saline (normal saline group); 100 mg ropivacaine (ropivacaine alone group) and 100 mg ropivacaine and 100 mg 2% lidocaine (ropivacaine with lidocaine group). Pain intensity was assessed after the operation using the 100-mm visual-analog scale (VAS), and the amount of supplemental analgesics used within the following 24 hours were recorded. Results The VAS scores of 2 hours postoperatively at rest, and 1, 2, 4, and 8 hours postoperatively at motion, were significantly higher in the normal saline group than in ropivacaine alone group (Plt;0.05). The VAS scores 0.5, 1 and 2 hours postoperatively at rest, and at the awaking moment, 0.5, 1, 4, 8, and 24 hours postoperatively at motion, were significantly higher in the normal saline group than in ropivacaine with lidocaine group (Plt;0.05). Conclusion Intra-articular ropivacaine can reduce a patient’s pain after operation. The combination of lidocaine with intra-articular ropivacaine can reduce the patient’s pain severity immediately after the operation and achieve an early analgesic effect.
