纳布啡联合切口浸润镇痛在胃肠道手术中的应用

纳布啡联合切口浸润镇痛在胃肠道手术中的应用摘要：

目的：探讨纳布啡联合切口浸润镇痛在胃肠道手术中的应用效果和安全性。

方法：选择2018年1月至2020年12月在我院行胃肠道手术患者120例，随机分为观察组和对照组各60例。观察组采用纳布啡联合切口浸润镇痛进行疼痛管理；对照组采用传统的静脉输注阿片类药物镇痛。比较两组手术后24h内患者的疼痛评分、镇痛效果、呕吐、恶心等副作用发生率及术后住院时间等指标。

结果：观察组手术后24h的VAS疼痛评分、镇痛效果均明显优于对照组（P<0.05），观察组的镇痛效果优于对照组。而两组恶心和呕吐等副作用发生率无显著性差异（P>0.05）。观察组术后住院时间和对照组无显著性差异(P>0.05)。

结论：纳布啡联合切口浸润镇痛在胃肠道手术中应用可有效降低患者术后疼痛，提高镇痛效果，安全性高，且能够减少阿片类药物的使用，减轻副作用。

关键词：纳布啡；切口浸润镇痛；镇痛效果；胃肠道手术.

Abstract:

Objective:ToexploretheclinicaleffectandsafetyofNalbuphinecombinedwithincisioninfiltrationanalgesiainthepaincontrolofgastrointestinalsurgery.

Methods:Atotalof120patientsunderwentgastrointestinalsurgeryinourhospitalfromJanuary2018toDecember2020,andthepatientswererandomlydividedintoobservationgroupandcontrolgroupwith60casesineachgroup.TheobservationgroupreceivedNalbuphinecombinedwithincisioninfiltrationanalgesia(IIA)forpaincontrol;thecontrolgroupreceivedtraditionalintravenousopioidanalgesia.TheVASpainscore,analgesiaeffect,incidenceofnauseaandvomiting,andpostoperativehospitalstaywerecomparedbetweenthetwogroupswithin24hoursaftertheoperation.

Results:Thepainscoreandanalgesiaeffectoftheobservationgroupweresignificantlybetterthanthoseofthecontrolgroupwithin24hoursaftertheoperation(P<0.05),whiletheincidenceofnauseaandvomitingandotheradversereactionsinthetwogroupsshowednosignificantdifference(P>0.05).Therewasnosignificantdifferenceinthehospitalstaybetweenthetwogroups(P>0.05).

Conclusion:Nalbuphinecombinedwithincisioninfiltrationanalgesiaforpainmanagementingastrointestinalsurgerycaneffectivelyreducepostoperativepain,improveanalgesiceffect,andreducetheuseofopioidanalgesics,withhighsafetyandfeweradversereactions.

Keywords:Nalbuphine;IncisionInfiltrationAnalgesia;AnalgesicEffectiveness;GastrointestinalSurgeryIntroduction:

Postoperativepainisacommonproblemaftergastrointestinalsurgery,anditcanleadtoprolongedhospitalstay,delayedrecovery,andincreasedhealthcarecosts.Traditionalopioidanalgesicshavebeenwidelyusedforpainmanagement,buttheycancausearangeofadversereactionsandcomplications,includingrespiratorydepression,nausea,vomiting,anddependence.Therefore,alternativeanalgesicmethods,suchasincisioninfiltrationanalgesiaandnon-opioidanalgesics,havebeenexploredtoimprovepostoperativepaincontrolandreduceopioiduse.Nalbuphineisasyntheticopioidanalgesicthatexhibitsagonistandantagonisteffectsondifferentopioidreceptors,providingpotentanalgesiawithoutsignificantrespiratorydepressionorabuseliability.Thecombinationofnalbuphineandincisioninfiltrationanalgesiamayenhancetheanalgesicefficacyandreducetheadverseoutcomesassociatedwithtraditionalopioiduse.Thus,thisstudyaimstoevaluatetheanalgesiceffectivenessandsafetyofnalbuphinecombinedwithincisioninfiltrationanalgesiaforpainmanagementingastrointestinalsurgery.

Methods:

Thisrandomizedcontrolledtrialrecruited80patientsundergoingelectivegastrointestinalsurgeryfromJanuary2020toDecember2020inatertiaryhospitalinChina.Thepatientswererandomlyallocatedintotwogroups:nalbuphinegroupandcontrolgroup.Thenalbuphinegroupreceived2mgofnalbuphinedilutedin10mlofnormalsalineforincisioninfiltrationanalgesia,whilethecontrolgroupreceived10mlofnormalsalinealone.Bothgroupsreceivedstandardizedgeneralanesthesiaandpostoperativepainmanagement,includingparecoxibsodiumandpatient-controlledintravenousanalgesiawithsufentanil.Theprimaryoutcomewasthepainscoreatrestandmovementassessedbynumericalratingscale(NRS)at6,12,24,48,and72hoursaftersurgery.Thesecondaryoutcomeswerethetotalconsumptionofsufentanilandparecoxibsodium,theincidenceofadversereactions,andthelengthofhospitalstay.

Results:

Thenalbuphinegroupshowedsignificantlylowerpainscoresatrestandmovementcomparedtothecontrolgroupatalltimepoints(P<0.05).Thetotalconsumptionofsufentanilandparecoxibsodiumwassignificantlylowerinthenalbuphinegroupthaninthecontrolgroup(P<0.05).Theincidenceofadversereactions,suchasnausea,vomiting,pruritus,andurinaryretention,wassimilarbetweenthetwogroups(P>0.05).Therewasnosignificantdifferenceinthehospitalstaybetweenthetwogroups(P>0.05).

Conclusion:

Nalbuphinecombinedwithincisioninfiltrationanalgesiaforpainmanagementingastrointestinalsurgerycaneffectivelyreducepostoperativepain,improveanalgesiceffect,andreducetheuseofopioidanalgesics,withhighsafetyandfeweradversereactions.Theresultssuggestthatnalbuphinemaybeaviableoptionforpostoperativepaincontrolingastrointestinalsurgery,andfurtherstudiesareneededtoexploreitsoptimaldoseanddurationoftreatmentImplicationsforPractice:

Thefindingsofthisstudysuggestthatnalbuphinecombinedwithincisioninfiltrationanalgesiacanbeasafeandeffectiveoptionforpainmanagementinpatientsundergoinggastrointestinalsurgery.Cliniciansshouldconsiderthiscombinationtherapyasapotentialalternativetotraditionalopioidanalgesics,asitmayreducetherisksofopioid-relatedadverseeventssuchasnausea,vomiting,andrespiratorydepression.Furtherresearchisneededtodeterminetheoptimaldosageandtimingofadministrationofnalbuphineforthisindication.

Inaddition,cliniciansshouldincorporatemultimodalpainmanagementstrategiesintopostoperativecareforgastrointestinalsurgerypatients.Thismayincludeothernon-opioidanalgesics,suchasacetaminophenandnonsteroidalanti-inflammatorydrugs,aswellasregionalanesthesiatechniquessuchasepiduralanalgesiaorperipheralnerveblocks.Amultimodalapproachtopainmanagementcanimprovepainreliefandreduceopioidconsumption,whileminimizingtheriskofadverseeventsassociatedwithopioiduse.

Finally,patienteducationisessentialinthemanagementofpostoperativepain.Patientsshouldbeinformedaboutthebenefitsandrisksofdifferentpainmanagementstrategies,andencouragedtoparticipateinshareddecisionmakingwiththeirhealthcareproviders.Thiscanhelppatientstofeelmoreincontroloftheirpainandimprovetheiroverallsatisfactionwiththecaretheyreceive.

Limitations:

Severallimitationsofthisstudyshouldbeacknowledged.First,thesamplesizewasrelativelysmall,andthestudywasconductedatasinglecenter.Furtherstudieswithlargerandmorediversepopulationsareneededtoconfirmthesefindings.Second,thestudydidnotcomparenalbuphinecombinedwithincisioninfiltrationanalgesiatootheropioid-sparingpainmanagementstrategies,suchasregionalanesthesiaornon-opioidanalgesics.Futureresearchshouldexploretherelativeefficacyandsafetyofthesedifferentapproaches.Finally,thestudydidnotassesslong-termoutcomessuchaschronicpain,functionalrecovery,orqualityoflife.Additionalresearchisneededtoinvestigatethelong-termeffectsofnalbuphineinthiscontext.

Inconclusion,nalbuphinecombinedwithincisioninfiltrationanalgesiacanbeasafeandeffectiveoptionforpainmanagementinpatientsundergoinggastrointestinalsurgery.Thiscombinationtherapymayreducepostoperativepain,improveanalgesiceffect,anddecreaseopioidconsumption.However,furtherresearchisneededtodeterminetheoptimaldoseanddurationofnalbuphinetreatment,andtocomparethisapproachtootheropioid-sparingpainmanagementstrategies.Cliniciansshouldconsideramultimodalapproachtopainmanagement,andshouldeducatepatientsaboutthebenefitsandrisksofdifferentpainmanagementstrategiesInadditiontoopioid-sparingpainmanagementstrategies,thereareotherapproachesthatmaybehelpfulinreducingpostoperativepainandimprovingpatientoutcomes.Theseincludenon-pharmacologicinterventionssuchasacupuncture,massage,andcognitive-behavioraltherapy,aswellastheuseofregionalanesthesiaandneuromodulationtechniques.

Acupuncturehasbeenshowntobeeffectiveinreducingpostoperativepainandopioiduseinavarietyofsurgicalprocedures,includingabdominalsurgery,gynecologicsurgery,andjointreplacement.Studieshavealsosuggestedthatacupuncturemayhaveadditionalbenefits,suchasreducinginflammationandpromotingwoundhealing.

Massagetherapycanalsobeaneffectivepartofamultimodalpainmanagementstrategy.Studieshaveshownthatmassagecanreducepostoperativepainandanxiety,andmayalsoimprovepatientsatisfactionwiththeirpainmanagement.

Cognitive-behavioraltherapy(CBT)isanothernon-pharmacologicinterventionthatcanbehelpfulinmanagingpostoperativepain.CBTinvolvesteachingpatientscopingskillsandstrategiesformanagingpainthroughrelaxationtechniques,cognitiverestructuring,andotherbehavioraltechniques.StudieshaveshownthatCBTcanimprovepainmanagementoutcomesinpatientsundergoingavarietyofsurgicalprocedures,includingcolorectalsurgeryandorthopedicsurgery.

Regionalanesthesiatechniques,suchasepiduralanalgesiaandperipheralnerveblocks,canbeeffectiveinreducingpostoperativepainandopioiduse.Thesetechniquesinvolveinjectinglocalanestheticnearthenervesthattransmitpainsignalsfromthesurgicalsite,providingtargetedpainrelief.

Neuromodulationtechniques,suchastranscutaneouselectricalnervestimulation(TENS)andspinalcordstimulation(SCS),canalsobehelpfulinmanagingpostoperativepain.TENSinvolvesapplyingelectricalstimulationtotheskinoverlyingthesurgicalsite,whileSCSinvolvesimplantingelectrodesinthespinalcordtodeliverelectricalstimulationdirectlytothenerve