摘要
目的观察罗哌卡因联合右美托咪定前锯肌平面阻滞对乳腺癌手术患者术后的镇痛效果。方法选择该院2023年5-10月择期行乳房改良根治性切除术患者90例,按随机数字表法分为R0.375组、DR0.375组和R0.500组,每组30例。3组患者术前行前锯肌平面阻滞,R0.375组患者的药物为0.375%罗哌卡因20 mL,DR0.375组患者的药物为0.375%罗哌卡因+1.0μg/kg右美托咪定混合液20 mL,R0.500组患者的药物为0.500%罗哌卡因20 mL。患者术后连接阿片类药物静脉自控镇痛泵。采用数字评定量表(NRS)评估患者术后1、2、6、12、24 h的静息痛和运动痛,计算疼痛-时间的曲线下面积(AUC);记录术后阿片类药物用量、首次使用镇痛药物的时间;采用美国麻醉医师协会(ASA)分级评估患者术后1 h的镇静状态;采用生活质量恢复量表(QoR-15)评估术后24 h生活质量;记录术后不良反应发生情况。结果DR0.375组和R0.500组的患者术后静息痛-时间的AUC和运动痛-时间的AUC较R0.375组患者均明显减少(P<0.05),术后12、24 h阿片类药物用量较R0.375组患者明显减少(P<0.05),术后QoR-15评分较R0.375组患者明显提高(P<0.05);R0.500组首次使用镇痛药物的时间较R0.375组明显延长(P<0.05);3组患者术后1 h均评估为轻度和中度镇静,组间比较差异无统计学意(P>0.05);3组患者术后不良反应发生情况比较,差异无统计学意义(P>0.05)。结论右美托咪定可以明显增强低浓度罗哌卡因用于前锯肌平面阻滞的镇痛效果,减少术后阿片类药物的用量。
Objective To observe the effect of ropivacaine combined with dexmedetomidine in serratus anterior plane block on postoperative analgesia in patients undergoing breast cancer surgery.Methods Ninety patients scheduled for modified radical mastectomy in this hospital from May to October 2023 were divided into three groups by using random number table method:the R0.375 group,the DR0.375 group and the R0.500 group,with 30 cases in each group.All the three groups received serratus anterior plane block before surgery.The R0.375 group was injected with 20 mL of 0.375% ropivacaine,the DR0.375 group with 20 mL of a mixture of 0.375% ropivacaine and 1.0μg/kg dexmedetomidine,and the R0.500 group with 20 mL of 0.500% ropivacaine.All patients received opioid-based patient-controlled intravenous analgesia pump after surgery.The numerical rating scale(NRS)was used to assess resting and movement pain at 1,2,6,12 and 24 hours postoperatively,and the pain-time area under the curve(AUC)was calculated.Postoperative opioid consumption,time of first analgesic drugs use were recoreded;sedation status at 1 hour postoperatively was evaluated by the American society of anesthesiologists(ASA)grading,quality of life at 24 hours postoperatively was assessed by the 15-item quality of recovery(QoR-15)scale,and postoperative adverse reactions were recorded.Results Compared with the R0.375 group,AUC of the resting pain-time and movement pain-time and the opioid consumption at 12 and 24 hours postoperatively of the DR0.375 group and the R0.500 groups were reduced(P<0.05),while QoR-15 score after surgery was increased(P<0.05).The time of first analgesic drugs use in the R0.500 group was significantly longer than that in the R0.375 group(P<0.05).At one hour after surgery,all the three groups were evaluated as having mild to moderate sedation,with no statistically significant differences among groups(P>0.05).There were also no statistically significant differences in the incidence of postoperative adverse reactions among the three groups(P>0.05).Conclusion Dexmedetomidine can significantly improve the analgesic effect of low-concentration ropivacaine in serratus anterior plane block and reduce postoperative opioid consumption.
作者
黄绿丹
朱微娟
黄静
朱晓娜
HUANG Lyudan;ZHU Weijuan;HUANG Jing;ZHU Xiaona(Department of Anesthesiology,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou,Zhejiang 325000,China)
出处
《重庆医学》
2025年第8期1854-1858,共5页
Chongqing Medical Journal
基金
浙江省温州市科技局科研基金项目(Y20220951)。
关键词
超声
前锯肌平面阻滞
右美托咪定
罗哌卡因
镇痛
乳腺癌
ultrasound
serratus anterior plane block
dexmedetomidine
ropivacaine
analgesia
breast cancer
