Comparison of ropivacaine, bupivacaine, prilocaine, and lidocaine in the management of pain and hemorrhage during nasal pack removal
Comparison of ropivacaine, bupivacaine, prilocaine, and lidocaine in the management of pain and hemorrhage during nasal pack removal
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DOI：
10.2500/ajra.2013.27.3945
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发表时间：
2013-09-01
影响因子：
2.6
通讯作者：
Saydam, Levent
中科院分区：
文献类型：
--
作者：
Gencer, Zeliha Kapusuz;Ozkiris, Mahmut;Saydam, Levent
背景资料：目的：探讨局部麻醉对鼻填塞物取出术后疼痛和出血的影响。其中72人为妇女，68人为男子。患者的平均年龄和体重为33.67 ± 10.2岁（范围：21-63岁）和69.6 ± 13.6 kg。将患者随机分为4组。四组中的三组在去除鼻腔填塞材料之前接受我们试验中研究的局部麻醉剂之一（利多卡因+肾上腺素、0.25%布比卡因或2%丙胺卡因），对照组接受生理盐水。在取出前15分钟，将局部麻醉剂和0.9%生理盐水溶液应用于Merocel鼻填塞物。每个病人都有一份问卷，记录了口头评分和术后出血量。（中位数，4;范围，3-5）利多卡因组，4.5 ± 1.2（中位数，4;范围3-5），布比卡因组为4.7 +/- 1.3（中位数，6;范围3-5），生理盐水组为6.35 +/- 1.2（中位数，6;范围5-7）。利多卡因组的疼痛评分明显优于其他组（p < 0.05）。布比卡因和丙胺卡因的疼痛评分分别显著优于对照组。对取出填塞物后出血评分的分析表明，所有三个研究组的出血评分均显著优于对照盐水组（p < 0.05）。结论：利多卡因局部应用于鼻中隔手术中，可减少患者的不适感，减少术中出血，提高患者的耐受性。
Background: This study investigates the effects of local anesthetics application on pain and hemorrhage caused by nasal pack removal.Methods: The study included 140 patients. Of these, 72 were women and 68 were men. The mean age and weight of the patients were 33.67 +/- 10.2 years (range, 21-63 years) and 69.6 +/- 13.6 kg. The patients were divided randomly into four groups. Three of the four groups received one of the local anesthetics studied in our trial (lidocaine + adrenaline, 0.25% bupivacaine, or 2% prilocaine) before removal of the nasal packing material and the control group received saline solution. Local anesthetics and 0.9% saline solution were applied to Merocel nasal packs 15 minutes before removal. Each patient was given a questionnaire where verbal analog score and amount of postoperative hemorrhage was noted.Results: The mean pain score was 3.5 +/- 1.2 (median, 4; range, 3-5) in the lidocaine group, 4.5 +/- 1.2 (median, 4; range 3-5) in the prilocaine group, 4.7 +/- 1.3 (median, 6; range, 3-5) in the bupivacaine group, and 6.35 +/- 1.2 (median, 6; range, 5-7) in the saline group during nasal packing removal. The lidocaine group had significantly better pain scores versus other groups (p < 0.05). Bupivacaine and prilocaine had significantly better pain scores versus the control group, respectively. Analysis of bleeding scores after pack removal showed that all three study groups had significantly better bleeding scores versus the control saline group (p < 0.05). The lidocaine group had significantly less bleeding score than bupivacaine and prilocaine groups (p < 0.05).Conclusion: Topical lidocaine application before removal of nasal packs in patients who undergo nasal septal surgery can decrease discomfort and bleeding and improve patient tolerance.