|
| 地塞米松或右美托咪定复合罗哌卡因髋关节囊周围神经阻滞对老年患者髋关节置换术后镇痛效果的影响 |
| Effects of dexamethasone or dexmedetomidine combined with ropivacaine for pericapsular nerve group block on postoperative analgesia in elderly patients undergoing hip replacement surgery |
| |
| DOI：10.12089/jca.2025.07.004 |
| 中文关键词: 罗哌卡因 髋关节囊周围神经阻滞 髋关节置换术 右美托咪定 地塞米松 老年 |
| 英文关键词: Ropivacaine Pericapsular nerve group block Hip replacement Dexmedetomidine Dexamethasone Aged |
| 基金项目:四川省南充市科技局市校科技战略合作项目（22SXQT0174）；四川省医学会专项科研项目（2024HR90） |
|
| 摘要点击次数: 1978 |
| 全文下载次数: 974 |
| 中文摘要: |
目的：比较地塞米松与右美托咪定复合罗哌卡因实施髋关节囊周围神经（PENG）阻滞对老年患者髋关节置换术后镇痛效果的影响。
方法：选择2023年1—12月择期行髋关节置换术的老年患者90例，男42例，女48例，年龄65～85岁，BMI 18.5～30.0 kg/m2，ASA Ⅰ—Ⅲ级。采用随机数字表法将患者分为三组：地塞米松组（DM组）、右美托咪定组（DX组）和对照组（C组），每组30例。患者入室后局麻下行患侧超声引导下PENG阻滞，药液均为20 ml，其中DM组为地塞米松0.1 mg/kg+0.25%罗哌卡因，DX组为右美托咪定0.5 μg/kg+0.25%罗哌卡因，C组为0.25%罗哌卡因。PENG阻滞后15 min，三组行相同方案的蛛网膜下腔阻滞（腰麻）。记录术后首次按压镇痛泵时间。记录术后0~12、＞12~24、＞24~48 h三个时间段镇痛泵总按压次数、镇痛泵有效按压次数。记录术中和术后不良反应的发生情况。于术后12、24 h评估股四头肌肌力。
结果：与C组比较，DM组和DX组术后首次按压镇痛泵时间明显延长，术后0~12、＞12~24、＞24~48 h镇痛泵总按压次数、镇痛泵有效按压次数明显减少（P<0.05）。与DX组比较，DM组术后首次按压镇痛泵时间明显延长，术后>12～24 h镇痛泵总按压次数、镇痛泵有效按压次数明显减少（P<0.05）。三组术中和术后不良反应发生率以及术后12、24 h股四头肌肌力差异无统计学意义。
结论：地塞米松和右美托咪定作为罗哌卡因的佐剂用于PENG阻滞，均能有效提高老年患者髋关节置换术后镇痛效果，其中地塞米松的效果更优。 |
| 英文摘要: |
Objective: To compare the effect of dexamethasone or dexmedetomidine combined with ropivacaine for pericapsular nerve group (PENG) block on postoperative analgesia in elderly patients undergoing hip replacement surgery.
Methods: Ninety elderly patients who were scheduled for elective hip replacement surgery during the period from January to December 2023, 42 males and 48 females, aged 65-85 years, BMI 18.5-30.0 kg/m2, ASA physical status Ⅰ-Ⅲ, were recruited. All the patients were randomly allocated into three groups by the random number table method: the dexamethasone group (group DM), the dexmedetomidine group (group DX), and the control group (group C), 30 patients in each group. Upon entering the operating room, the patients in each group were injected with a fixed volume of 20 ml of local anesthetic under ultrasound-guided PENG block. The drugs for PENG block were dexamethasone 0.1 mg/kg + 0.25% ropivacaine in group DM, dexmedetomidine 0.5 μg/kg + 0.25% ropivacaine in group DX, and 0.25% ropivacaine in group C. The same scheme of subarachnoid anesthesia (spinal anesthesia) was performed 15 minutes after PENG block. The time of the postoperative first compression of the analgesic pump was recorded. The total number and the effective number of compressions of the analgesic pump in the three time periods of 0-12, > 12-24, and > 24-48 hours after the operation were recorded. The occurrence of intraoperative and postoperative adverse reactions was recorded. The quadriceps muscle strength was measured 12 and 24 hours after the operation.
Results: Compared with group C, the time of the postoperative first compression of the analgesic pump in groups DX and DM was significantly prolonged, the total number and the effective number of compressions of the analgesic pump were significantly reduced 0-12, > 12-24, and > 24-48 hours after the operation (P < 0.05). Compared with group DX, the time of the postoperative first compression of the analgesic pump in group DM was significantly prolonged, the total number of compressions and the effective number of compressions of the analgesic pump > 12-24 hours after the operation were significantly reduced (P < 0.05). There was no significant differences in intraoperative or postoperative adverse reaction rates among the three groups. There was no statistically significant difference in the quadriceps muscle strength among the three groups 12 and 24 hours after the operation.
Conclusion: Both dexamethasone and dexmedetomidine, as adjuvants added into ropivacaine for PENG block, can effectively improve perioperative analgesia, and the effect of dexamethasone is more prominent in elderly patients undergoing hip replacement surgery. |
|
查看全文
查看/发表评论 下载PDF阅读器 |
| 关闭 |
|
|
|
