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| 复方倍他米松复合罗哌卡因胸椎旁阻滞用于胸腔镜术后镇痛的效果 |
| Effect of compound betamethasone combined with ropivacaine on the thoracic paravertebral block for analgesia after thoracoscopic surgery |
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| DOI：10.12089/jca.2024.04.006 |
| 中文关键词: 复方倍他米松 罗哌卡因 胸椎旁阻滞 胸腔镜 术后镇痛 |
| 英文关键词: Compound betamethasone Ropivacaine Thoracic paravertebral block Thoracoscopy Postoperative analgesia |
| 基金项目:广东省医学科学技术研究基金（A2021400，B2018001）；揭阳市医疗卫生科技创新项目（YLWS005） |
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| 中文摘要: |
目的：探讨超声引导下复方倍他米松复合罗哌卡因胸椎旁阻滞用于胸腔镜术后镇痛的效果。
方法：选择行择期胸腔镜手术患者60例，男41例，女19例，年龄18～60岁，BMI 18～25 kg/m2，ASA Ⅰ或Ⅱ级。采用随机数字表法将患者分为两组：复方倍他米松复合罗哌卡因组（B组）和罗哌卡因组（R组），每组30例。两组在麻醉诱导前行超声引导下胸椎旁阻滞，B组注射药物为加入复方倍他米松0.5 ml的0.4%罗哌卡因25 ml，R组注射药物为0.4%罗哌卡因25 ml。两组均采用标准化的支气管插管静脉全麻方案，术后行PCA。记录阻滞起效时间、镇痛持续时间、PCA首次按压时间，术中舒芬太尼、瑞芬太尼、丙泊酚用量，术后2、4、8、12、24、48 h 静息和活动时（咳嗽）VAS疼痛评分，术后48 h PCA总按压次数和舒芬太尼补救镇痛例数，术后48 h内呼吸抑制、恶心呕吐、穿刺部位感染、尿潴留等不良反应发生情况。
结果：与R组比较，B组阻滞起效时间明显缩短（P＜0.05），镇痛持续时间、PCA首次按压时间明显延长（P＜0.05）。两组术中舒芬太尼、瑞芬太尼、丙泊酚用量差异均无统计学意义。与R组比较，B组术后8、12和24 h静息和活动时VAS疼痛评分明显降低（P＜0.05），术后48 h PCA总按压次数明显减少（P＜0.05）,舒芬太尼补救镇痛率明显降低（P＜0.05）。两组术后48 h内呼吸抑制、恶心呕吐、穿刺部位感染、尿潴留差异均无统计学意义。
结论：与单纯罗哌卡因比较，复方倍他米松作为罗哌卡因佐剂超声引导下胸椎旁阻滞用于胸腔镜手术围术期镇痛，能增强阻滞及镇痛效果，减少阿片类镇痛药物使用。 |
| 英文摘要: |
Objective: To explore the analgesic effect of thoracic paravertebral block (TPVB) under ultrasound guidance using a compound solution of betamethasone and ropivacaine for post-thoracoscopic surgery analgesia.
Methods: Sixty patients scheduled for elective thoracoscopic surgery were selected, including 41 males and 19 females, aged 18-60 years, BMI 18-25 kg/m2, and ASA physical status Ⅰ or Ⅱ. Patients were randomly divided into two groups: the betamethasone combined with ropivacaine group (group B) and the ropivacaine group (group R), 30 patients in each group. Before anesthesia induction, both groups received TPVB under ultrasound guidance, with group B receiving 0.4% ropivacaine 25 ml mixed with compound betamethasone 0.5 ml, and group R receiving 0.4% ropivacaine 25 ml. Both groups underwent a standardized general anesthesia protocol with bronchial intubation and PCA. The onset time of block, duration of analgesia, first PCA pressing time, intraoperative sufentanil, remifentanil, and propofol consumption, resting and activity (coughing) VAS pain scores at 2, 4, 8, 12, 24, and 48 hours postoperatively, total PCA pressings and sufentanil rescue analgesia cases within 48 hours postoperatively, and adverse reactions such as respiratory depression, nausea and vomiting, puncture site infection, and urinary retention within 48 hours postoperatively were recorded.
Results: Compared with group R, group B had significantly shorter onset time of block and longer duration of analgesia and first PCA pressing time (P < 0.05). There was no significant difference in intraoperative sufentanil, remifentanil, and propofol consumption between the two groups. Compared with group R, group B had significantly lower resting and activity VAS pain scores at 8, 12, and 24 hours postoperatively (P < 0.05), and significantly fewer total PCA pressings and cases of sufentanil rescue analgesia within 48 hours postoperatively (P < 0.05). There was no significant difference in the incidence of adverse reactions such as respiratory depression, nausea and vomiting, puncture site infection, and urinary retention within 48 hours postoperatively between the two groups.
Conclusion: Compared with ropivacaine alone, the use of compound betamethasone as an adjuvant to ropivacaine for ultrasound-guided TPVB in perioperative analgesia for thoracoscopic surgery can enhance the blocking and postaperative analgesic effects, and reduce the use of opioid analgesics. |
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