右美托咪定腹横肌平面阻滞对腹腔镜结肠根治术后恢复的影响

Effect of Ultrasound-guided Subcostal Transverses Abdominis Plane Block with Dexmedetomidine after Laparoscopic Radical Operation on Colon

目的观察腹腔镜下结肠根治术后右美托咪定超声引导下腹横肌平面(TAP)阻滞的镇痛效果,及其对早期恢复的影响。方法腹腔镜下结肠癌根治术患者40例均分为右美托咪定组(DEX组)和对照组(CON组)。手术结束后在超声引导下行TAP阻滞。DEX组予右美托咪定1μg/kg+0.25%罗哌卡因至20 ml,CON组予0.25%罗哌卡因20 ml。记录术后2 h、6 h、12 h、24 h、48 h静息状态、咳嗽时疼痛视觉模拟评分(VAS)和Ramsay评分,记录最高感觉阻滞平面、感觉阻滞维持时间、术后首次镇痛泵按压时间和术后第一天总按压次数和舒芬太尼用量,患者术后首次排气时间、进食时间和住院时间。结果术后2 h、6 h、12 h,DEX组VAS评分显著低于CON组(P<0.001),Ramsay评分明显高于CON组(P<0.01);DEX组较CON组感觉阻滞维持时间显著延长(P<0.001),首次镇痛泵按压时间显著较晚(P<0.001),镇痛泵按压次数显著减少(P<0.001),舒芬太尼用量显著减少(P<0.001);DEX组术后首次排气时间、进食时间和出院时间显著早于CON组(P<0.001)。结论右美托咪定能显著增强罗哌卡因的TAP阻滞效果,减轻术后疼痛,促进术后恢复。

Objective To investigate the effect of ultrasound-guided subcostal transverses abdominis plane（TAP） block with dexmedetomidine after laparoscopic radical operation. Methods 40 patients underwent laparoscopic radical operation for colorectal cancer were randomized into dexmedetomidine group（group DEX） and control group（group CON）. All the patients received ultrasound-guided subcostal TAP block after operation, Group DEX with dexmedetomidine 1 μ g/kg and 0.25% ropivacaine to 20 ml, and group CON with 0.25% ropivacaine 20 ml. All the patients were assessed with Ramsay scores and the pain at rest and on coughing were assessed with Visual Analogue Scale（VAS）, 2, 6, 12, 24 and 24 hours after operation. The highest level and the duration of sensory blockade, the first time and the total times of pressing the analgesia pump in the first day after operation, and the requirements of sufentanil were recorded. First flatus time, first diet time and the length of hospital stay were compared. Results The scores of VAS were significantly less（P〈0.001）, and the Ramsay scores were more in the group DEX than in the group CON（P〈0.01） 2, 6 and 12 hours after operation; with the longer time of sensory blockade（P〈0.001）, the later to first press the analgesia pump（P〈0.001）, the less frequence of pressing the analgesia pump（P〈0.001）, and less dosage of sufentanil（P〈0.001）. The first flatus time, first diet time were significantly earlier in the group DEX than in the group CON（P〈0.001）, with the less length of total hospital stay（P〈0.001）. Conclusion Dexmedetomidine can promote the anaesthesia of ultrasound-guided subcostal TAP block with ropivacaine and improve the recovery after laparoscopic radical operation.