摘要
目的研究右美托咪定联合罗哌卡因超声引导下竖脊肌平面阻滞(ESPB)用于肋骨骨折患者术后镇痛的有效性及安全性。方法选取于2019年1月至2019年10月在首都医科大学附属北京同仁医院接受肋骨骨折术的患者40例,按随机数字表法分为右美托咪定联合罗哌卡因组(DR组)和罗哌卡因组(R组),每组各20例。2组在全麻插管后超声引导下患侧行ESPB,DR组患者注射0. 5μg/kg右美托咪定+0. 375%罗哌卡因共20 mL,R组患者注射0. 375%罗哌卡因20 mL,2组均行静脉自控镇痛(PCIA),观察并记录2组患者术后首次按压镇痛泵的时间,术后4、8、12、24和48 h患者的静息和活动状态下VAS评分,术后48 h内PCIA按压次数,以及并发症、不良反应发生率。结果 DR组患者首次按压镇痛泵的时间为(5. 8±1. 8)h,显著长于R组(2. 7±1. 6)h,差异有统计学意义(P<0. 05);与R组比较,DR组术后8、12、24、48 h的静息和活动状态下VAS评分均显著降低,差异有统计学意义(P<0. 05);除手术后到术后4 h时间段外,其余各相邻时间点镇痛泵按压次数DR组显著少于R组,差异有统计学意义(P<0. 05)。2组患者均未观察到ESPB相关并发症和不良反应。结论采用0. 5μg/kg右美托咪定联合0. 375%的罗哌卡因行ESPB能够为肋骨骨折患者提供更为理想的术后多模式镇痛效果,还能减少术后镇痛药物用量,且无明显不良反应。
Objective To identify the effectiveness and safety of dexmedetomidine added to ropivacaine on erector spinae plane block for postoperative analgesia after internal fixation for rib fracture.Methods Forty patients in Beijing Tongren Hospital Affiliated to Capital Medical University underwent internal fixation for rib fracture from January 2019 to October 2019 were randomly divided into the group DR and the group R. Affected side ESPB was completed with totally 20 mL 0. 375% ropivacaine and 0. 5 μg/kg dexmedetomidine for the group DR and only totally 20 mL 0. 375% ropivacaine for group R. Patientcontrolled intravenous analgesic(PCIA)pumps were started at the end of surgery. Time elapsed for the first additional analgesia request was recorded. Rest and activity VAS score,frequency of PCIA pressed at 4,8,12,24 and 48 h after operation,adverse reaction were also compared.Results The time elapsed for the first additional analgesia request in the group DR(5. 8±1. 8)h were significantly higher than that in group R(2. 7±1. 6)h(P<0. 05). Compared with the group R,rest and activity VAS score were significantly lower at postoperative 8,12,24,48 h(P<0. 05). The frequency of PCIA pressed in the group DR were significantly lower than that in group R at 4-8 h,8-12 h,12-24 h,24-48 h time intervals(P<0. 05). Patients in both groups had no ESPB-related complication and adverse reactions. Conclusion Adding 0. 5 μg/kg dexmedetomidine to 0. 375%ropivacaine in ESPB potentiates the analgesic properties of ropivacaine,reduces opium consumption and safely provides a good pain control after internal fixation for rib fracture and not increases the adverse drug reactions.
作者
包音
王古岩
王惠军
李梅
BAO Yin;WANG Gu-yan;WANG Hui-jun;LI Mei(Department of Anesthesiology,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)
出处
《临床药物治疗杂志》
2020年第6期31-34,共4页
Clinical Medication Journal
关键词
右美托咪定
罗哌卡因
竖脊肌平面阻滞
肋骨骨折
术后镇痛
dexmedetomidine
ropivacaine
erector spinae plane block
rib fractures
postoperative analgesia
