地塞米松及舒芬太尼对罗哌卡因硬膜外镇痛效果的影响

Efficacy of dexamethasone versus sufentanil to epidural ropivacaine on postoperative analgesia

【目的】本地塞米松及舒芬太尼对罗哌卡因硬膜外镇痛效果的影响。【方法】120名拟行下腹部手术的患者被随机分配成3组接受硬膜外镇痛。R组:0.5%罗哌卡因5 ml(25 mg)+生理盐水5 ml;RS组:0.5%罗哌卡因5 ml+0.00016%舒芬太尼溶液5ml;RD组:0.5%罗哌卡因5 ml+0.08%地塞米松溶液5 ml。给予试验药物后以视觉模拟评分(visual analogue score,VAS)评估患者的疼痛情况,记录患者首次追加镇痛时间、术后24 h哌替啶需求总量、需要追加镇痛的患者例数等信息及患者术后恶心、呕吐、瘙痒、尿潴留、呼吸抑制的发生情况。【结果】RS组(罗哌卡因+舒芬太尼)和RD组(罗哌卡因+地塞米松)的术后首次镇痛时间明显长于R组(单纯罗哌卡因)(P<0.05),RS组和RD组的术后哌替啶的总用量及主动要求追加镇痛的患者例数亦明显少于R组(P<0.05)。【结论】硬膜外给予地塞米松可以明显增强罗哌卡因的术后镇痛作用,延长其镇痛时间,同时减少术后阿片类药物的需求,并减少使用阿片类药物导致的不良反应。

[Objective] To evaluate the effect of adding dexamethasone or sufentanil to epidural ropivacaine on postoperative analgesia. [Methods] One hundred and twenty patients ASA I-II scheduled for lower abdominal surgeries were randomly allocated into three groups to receive a total of 10 mL epidural plain ropivacaine 0.25% in the control group （group R）, with either 8 μg sufentanil in group RS or 4 mg dexamethasone in group RD. Patients＇ visual analogue pain scores（VAS） were measured postoperatively. Postoperative meperidine consumption, number of patients requiring analgesia and the time to first analgesic requirement were recorded. [ Results] Time to first analgesic requirement was significantly prolonged in the RS group and the RD group compared with group R （P 〈 0.01）. There was significant reduction in postoperative meperidine consumption during the first 24 h in the RS and RD groups in comparison with group R （P 〈 0.01）. VAS scores were siguificantly lower a in the RS and RD groups compared with group R （P 〈 0.01）. Postoperative nausea was significantly lower in the RD group versus the R and RS groups （P 〈 0.01）. Postoperative pruritus was significantly lower in the RD and R groups versus the RS group （P 〈 0.01）. [Conclusion ] This study revealed that epidural ropivacaine-dexamethasone mixture have almost the same analgesic potency as ropivacaine-sufentanil with opioid sparing and antiemetic effects.