观察腹腔镜阑尾切除术(LA)中应用局部麻醉药物对术后疼痛的疗效。

选取2020年3月至2023年3月于澄迈县人民医院行LA的120例患者，采用随机字母表法将患者分为4组，对照组、利多卡因组、左旋布比卡因组、罗哌卡因组，每组各30例。术中分别给药，比较四组患者在全身麻醉苏醒后的2 h、6 h、12 h、24 h及48 h的疼痛程度、术后疼痛的特征和频率、术前和术后48h的生活质量评分(SF-36量表)及术后48h内不良反应发生率。

4组患者年龄、性别、BMI、ASA分级、麻醉时间、术中出血量、手术时间比较差异无统计学意义(P>0.05)。与对照组相比，利多卡因组、左旋布比卡因组、罗哌卡因组的首次下床活动时间、住院时间减少(P<0.05)；利多卡因组、左旋布比卡因组、罗哌卡因组术后2 h、6 h、12 h、24 h、48 h的VAS评分均降低，VAS评分降低由高到低分别为左旋布比卡因组、罗哌卡因组、利多卡因组(P<0.001)；利多卡因组、左旋布比卡因组、罗哌卡因组的疼痛频率较低，以钝痛为主(P<0.05)。4组患者术前48 h的SF-36量表各维度(躯体疼痛、健康指数、情感及生活满意度)评分无统计学意义(P>0.05)，术后48 h SF-36量表各维度评分均显著高于治疗前(P<0.05)；利多卡因组、左旋布比卡因组、罗哌卡因组的各维度评分均高于对照组，SF-36量表评分升高由高到低分别为左旋布比卡因组、罗哌卡因组、利多卡因组(P<0.001)。4组患者术后48 h内的不良反应发生率比较，差异无统计学意义(P>0.05)。

局部麻醉药物对行LA术后的阑尾炎患者的镇痛效果明显，可有效改善阑尾炎患者LA术后的生活质量，未增加不良反应。

To observe the efficacy of local anesthetic drugs applied during laparoscopic appendectomy(LA)on postoperative pain.

This study prospectively included 120 patients who underwent LA in our hospital from March 2020 to March 2023, and all patients were randomly divided into control group, lidocaine group, levobupivacaine group and ropivacaine group, with 30 patients in each group.The pain levels at 2 h, 6 h, 12 h, 24 h and 48 h after awakening from general anesthesia, characteristics and frequency of postoperative pain, quality of life scores(SF-36 scale)before and 48 h after surgery, and the incidence of adverse reactions at 48 h after surgery were compared among the four groups, respectively.

There were no significant differences in age, gender, BMI, ASA classification(gradeⅠandⅡ), anesthesia time, intraoperative bleeding and operative time among the four groups(P>0.05), but the time to first bed activity and hospital stay were reduced in the lidocaine, levobupivacaine and ropivacaine groups compared with the control group, with statistically significant differences(P<0.05). Compared with the control group, the VAS scores at 2, 6, 12, 24 and 48 h after surgery were reduced in the lidocaine, levobupivacaine and ropivacaine groups, but the VAS score was most significantly reduced in the levobupivacaine group, followed by the ropivacaine group, and finally the lidocaine group, with statistically significant differences(P<0.001). Compared with the control group, the lidocaine, levobupivacaine and ropivacaine groups had lower pain frequency and predominantly dull pain, with statistically significant differences(P<0.05). There was no statistically significant difference in the SF-36 scale scores for each dimension(somatic pain, health index, emotion and life satisfaction)among the four groups 48 h before surgery(P>0.05). The SF-36 scale scores for each dimension at 48 h after surgery were significantly higher than those before treatment(P<0.05), and after treatment, the scores for each dimension in the lidocaine, levobupivacaine and ropivacaine groups were higher than those in the control group, with the SF-36 scale scores in the levobupivacaine group being the most significantly elevated, followed by the ropivacaine group and finally the lidocaine group, with statistically significant differences(P<0.001). There was no statistically significant difference in the overall incidence of adverse reactions among the four groups within 48 h(P>0.05).

Local anesthetic drugs have a significant analgesic effect on patients with appendicitis after performing LA, and can effectively improve the quality of life of patients with appendicitis after LA.