右美托咪定混合罗哌卡因关节腔注射用于膝关节镜术后镇痛的临床效果

Clinical efficacy of intra-articular dexmedetomidine mixed with ropivacaine for postoperative analgesia after arthroscopic knee surgery

目的 评价膝关节镜术后关节腔注射右美托咪定混合罗哌卡因的镇痛效果.方法 关节镜诊治术患者60例,ASA分级Ⅰ或Ⅱ级,采用随机数字表法分为2组（n=30）,手术结束时,分别关节腔注射生理盐水1ml混合0.25％罗哌卡因19 ml（R组）或右美托咪定1μg/kg混合0.25％罗哌卡因19 ml（RD组）,于术后1～24h分别观察动态及静态VAS评分,记录术后镇痛持续时间（从关节腔注药后即刻至首次芬太尼辅助给药的时间）及术后24h芬太尼用量.结果 与R组相比,RD组术后1、2、4和8h时静态及动态VAS评分降低（P＜0.05或0.01）;术后镇痛持续时间明显延长,术后24h芬太尼用量明显减少（P＜0.01）;而术后12～24 h两组VAS评分差异无统计学意义（P＞0.05）.结论 关节腔注射右美托咪定可明显增强局部罗哌卡因用于患者膝关节镜术后镇痛的效果.

Objective To evaluate the efficacy of intra-articular dexmedetomidine mixed with ropivacaine for postoperative analgesia after arthroscopic knee surgery.Methods Sixty ASA physical status Ⅰ or Ⅱ patients,aged 20-64 yr,weighing 50-90 kg,with body height 160-180cm,scheduled for elective arthroscopic knee surgery,were randomly assigned into 2 equal groups using a random number table：ropivacaine group （group R） and dexmedetomidine mixed with ropivacaine group （group RD）.In group R,the mixture of noraml saline 1 ml and 19 ml of 0.25% ropivacaine was injected intra-articularly at the end of surgery.In group RD,the mixture of dexmedetomidine 1 μg/kg and 19 ml of 0.25% ropivacaine was injected intra-articularly at the end of surgery.VAS scores at rest and during activity were observed and recorded at 1,2,4,8,12,20 and 24 h after surgery.The duration of analgesia after sugery （from the time immediately after intra-articular administration to the time of first administration of fentanyl as an adjunct to analgesia） and consumption of fentanyl at 24 h after surgery were recorded.Results Compared with group R,VAS scores were significantly decreased at 1,2,4 and 8 h after surgery,the duration of analgesia after sugery was prolonged,and the consumption of fentanyl at 24 h after surgery was reduced in group RD （P 〈 0.05 or 0.01）.There was no significant difference in VAS scores at 12-24 h after surgery between the two groups （P 〉 0.05）.Conclusion Intra-articular dexmedetomidine can significantly improve the efficacy of ropivacaine for postoperative analgesia after arthroscopic knee surgery.