评估布比卡因用于鼻整形术后疼痛管理的有效性：一项三盲对照临床试验

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中文摘要

背景： 鼻整形术常伴随明显的术后疼痛，因此有效的疼痛管理对于提高患者满意度和促进康复至关重要。本研究评估长效局部麻醉药布比卡因在管理鼻整形术患者术后疼痛中的有效性。
方法： 开展了一项随机三盲对照临床试验，纳入220名年龄17至50岁、ASA I级的参与者。参与者被随机分配到四组之一：对照组（不使用布比卡因）、注射组（通过神经阻滞注射4 ml布比卡因）、局部组（将布比卡因浸泡的网片置于鼻孔内）和联合组（局部与注射联合）。在术后1、6、24、48和72小时评估疼痛水平。次要结局包括镇痛药消耗量、术后恶心呕吐的发生率以及患者并发症。
结果： 共有212名患者完成了研究。在术后1、6、24和72小时，局部组报告的疼痛水平显著低于其他组。注射组和联合组的镇痛药消耗量显著更低。此外，联合组的术后恶心呕吐发生率更低，并报告了更高的总体满意度，其中79.2%将其体验评为“好于预期”（p = 0.020）。
结论： 布比卡因的使用，尤其是通过局部和注射两种方法联合应用时，可极大改善鼻整形术后的疼痛管理。该技术不仅减轻疼痛和镇痛药需求，还提高患者满意度并减少副作用。
证据等级II： 本期刊要求作者为每篇文章指定证据等级。有关这些循证医学评级的完整说明，请参阅目录或在线作者须知 www.springer.com/00266 。

英文摘要

BACKGROUND: Rhinoplasty is often accompanied by significant postoperative pain, making effective pain management crucial for enhancing patient satisfaction and facilitating recovery. This study evaluates the effectiveness of bupivacaine, a long-acting local anesthetic, in managing postoperative pain for patients undergoing rhinoplasty.
METHODS: A randomized triple-blind controlled clinical trial was conducted involving 220 participants aged 17 to 50 years, classified as ASA I. Participants were randomly assigned to one of four groups: control (no bupivacaine), injection (4 ml of bupivacaine via nerve block), topical (bupivacaine-soaked mesh placed in the nostrils), and combination (both topical and injection). Pain levels were assessed at 1, 6, 24, 48, and 72 h post-surgery. Secondary outcomes included analgesic consumption, the incidence of postoperative nausea and vomiting, and patient complications.
RESULTS: A total of 212 patients completed the study. At 1, 6, 24, and 72 h post-surgery, the topical group reported significantly lower pain levels compared to other groups. Analgesic consumption was significantly lower in both the injection and combination groups. Additionally, the combination group had lower rates of postoperative nausea and vomiting and reported higher overall satisfaction, with 79.2% rating their experience as "better than they expected" (p = 0.020).
CONCLUSION: The use of bupivacaine, especially when applied combined, through both topical and injection methods, greatly improves pain management after rhinoplasty. This technique not only decreases pain and the need for analgesics but also enhances patient satisfaction and reduces side effects.
LEVEL OF EVIDENCE II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .