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| 罗哌卡因复合右美托咪定或地塞米松竖脊肌平面阻滞用于腰椎后路植骨融合内固定术的效果 |
| Effect of ropivacaine combined with dexmedetomidine or dexamethasone for erector spinal plane block in lumbar posterior implant fusion internal fixation |
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| DOI：10.12089/jca.2021.09.004 |
| 中文关键词: 右美托咪定 地塞米松 罗哌卡因 竖脊肌平面阻滞 |
| 英文关键词: Dexmedetomidine Dexamethasone Ropivacaine Erector spinae plane block |
| 基金项目:浙江省医学会临床科研基金项目(2016ZYC-A77)；嘉兴市科技计划项目(2020AD30136) |
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| 中文摘要: |
目的 比较罗哌卡因复合右美托咪定或地塞米松竖脊肌平面阻滞(ESPB)在腰椎后路植骨融合内固定术中的临床效果。
方法 选择2019年10月至2020年10月择期行腰椎后路植骨融合内固定术患者75例,男42例,女33例,年龄35~65岁,BMI 18~35 kg/m2,ASA Ⅰ或Ⅱ级。采用随机数字表法将患者分为三组：罗哌卡因复合右美托咪定组(RX组)、罗哌卡因复合地塞米松组(RS组)和单纯罗哌卡因组(R组)。三组麻醉诱导前均行ESPB,RX组两侧分别注射0.375%罗哌卡因+右美托咪定0.5 μg/kg混合液20 ml,RS组两侧分别注射0.375%罗哌卡因+地塞米松5 mg混合液20 ml,R组两侧分别注射0.375%罗哌卡因20 ml。记录术中瑞芬太尼和舒芬太尼用量。记录术后4、8、12、24、48 h静息和翻身时数字评价量表(NRS)评分。记录感觉阻滞持续时间、镇痛泵首次按压时间和补救镇痛例数。记录术后24 h内镇痛满意度及术后当晚睡眠质量。记录术后下肢运动阻滞、穿刺部位血肿、恶心呕吐、低血压、心动过缓、手术部位感染和切口延迟愈合等发生情况。
结果 与R组比较,术后12、24 h RX组和RS组静息和翻身时NRS评分明显降低(P<0.05),感觉阻滞时间和镇痛泵首次按压时间明显延迟(P<0.05),补救镇痛率明显降低(P<0.05),24 h内镇痛效果及术后当晚睡眠质量满意度评分明显升高(P<0.05)。三组穿刺部位血肿和恶心呕吐发生率差异无统计学意义。三组均无一例发生术后下肢运动阻滞、低血压、心动过缓、手术部位感染和切口延迟愈合。
结论 右美托咪定或地塞米松复合罗哌卡因用于后路腰椎手术竖脊肌阻滞,可以延长感觉阻滞时间,有效控制术后急性疼痛,临床效果相似。 |
| 英文摘要: |
Objective To compare the clinical effects of ropivacaine combined with dexmedetomidine or dexamethasone for erector spinal plane block (ESPB) in lumbar posterior implant fusion internal fixation.
Methods Seventy-five patients from October 2019 to October 2020, 42 males and 33 females, aged 35-65 years, BMI 18-35 kg/m2,ASA physical status Ⅰ or Ⅱ, were randomly divided into three groups using random number table method: 0.375% ropivacaine + dexmedetomidine 0.5 μg/kg mixture 20 ml (group RX), 0.375% ropivacaine + dexamethasone 5 mg mixture 20 ml (group RS) and 0.375% ropivacaine 20 ml (group R). ESPB was performed before induction of anesthesia in all three groups. Intraoperative remifentanil and sufentanil use was recorded. The numeric rating scale (NRS) scores with resting and active states at 4, 8, 12, 24, and 48 hours postoperatively were recorded. Duration of sensory block, time to first analgesic pump press, and number of cases of remedial analgesia were recorded. Assessment of satisfaction with analgesic effect within 24 hours postoperatively and quality of sleep on the postoperative night were recorded. The occurrence of postoperative lower limb motor block,puncture site hematoma, nausea and vomiting, hypotension,bradycardia, surgical site infection and delayed incision healing were recorded.
Results Compared with group R, groups RX and RS had significantly lower resting and active state NRS scores at 12 and 24 hours postoperatively (P < 0.05), delayed sensory block time and first press of the analgesic pump (P < 0.05), significantly lower rates of remedial analgesia (P < 0.05), and significantly higher analgesic effects at 24 hours and sleep quality satisfaction scores on the night after surgery (P < 0.05). There was no statistically significant difference in the incidence of puncture site hematoma and nausea and vomiting among the three groups. None of the three groups experienced postoperative lower limb motor block, hypotension, bradycardia, surgical site infection, or delayed healing of the incision.
Conclusion Dexmedetomidine or dexamethasone as an adjuvant to ropivacaine for posterior lumbar surgery with prolonged sensory blockade and effective control of acute postoperative pain with similar results． |
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