关节腔内给予右美托咪定对膝关节镜术后镇痛的影响

The effects of intra-articular infusion dexmedetomidine on postoperative analgesia in patients with arthroscopic knee surgery

目的本研究评价关节腔内给予右美托咪定对膝关节镜术后镇痛的影响。方法拟行膝关节镜手术患者60例,随机均分为三组:关节组关节腔内给予右美托咪定0.7μg/kg(用生理盐水配置成15ml),静脉给予生理盐水15ml;静脉组静脉内给予右美托咪定0.7μg/kg(用生理盐水配置成15ml),关节腔内给予生理盐水15ml;对照组静脉和关节腔内给予生理盐水各15ml。记录患者术后静息时和运动时VAS评分和术后2h改良Ramsay镇静评分,以及术毕至首次需要镇痛药时间和术后24h内曲马多用量。结果关节组术后1～6h,静脉组术后1h静息时和运动时VAS评分明显低于对照组(P<0.05)。首次使用镇痛药时间,关节组(198.0±50.5)min明显长于静脉组(97.0±39.5)min和对照组(62.0±28.1)min(P<0.01)。使用曲马多剂量关节组(82.0±36.5)mg明显低于静脉组(119.2±44.1)mg和对照组(163.0±52.5)mg(P<0.01),静脉组又明显低于对照组(P<0.05)。术后2h改良Ramsay镇静评分静脉组明显高于关节组和对照组(P<0.05)。结论关节腔内给予右美托咪定可提供膝关节镜术后的有效镇痛,延长术后首次使用镇痛药的时间和减少术后镇痛药的使用。

Objective To evaluate the effects of intra-articular dexmedetomidine on postoperative analgesia in patiets with arthroseopic knee surgery. Methods Sixty patients undergoing arthroseopie knee surgery were randomly assigned into three groups in a double-blind placebo controlled study. The intra-artieular group was given dexmedetomidine 0.7μg/kg （make the volume to 15 ml with saline） intra-articular and 15 ml saline intravenously. The vein group was received dexmedetomidine intravenously and saline intra-artieular, while the control group was 15 ml saline intravenously and intra-articular respectively. Haemodynamic changes, pain visual analogue scale （VAS）, sedation score, the time to first postoperative analgesic request, and the total postoperative analgesic use during the first 24 h were evaluated. Results The intra-articular group was got a significant reduction in pain scores for 6 h after operation but only for 1 h in the vein group. The time to first postoperative analgesic request was longer in the intra articular group （198. 0 ±50.5） rain compared with the vein group （97.0± 39.5） min and the control group （62.0±28. 1） min （P〈0.01 ）. Total tramadol requirement was significantly lower in the intra-articular group （82.0±36.5） mg than in the vein group （119.2±44.1） mg and in the control group （163.0±52.5） mg （P〈 0.01）. The Ramsay sedation score at 2 h postoperatively in vein group was significantly higher than that in the intra-articular group and the control group （P 〈 0. 05）. Conclusion Intra-articular dexmedetomidine enhanced postoperative analgesia after arthroseopic knee surgery, with an increased time to first analgesic request and a decreased analgesic need for postoperative analgesia.