右美托咪定联合罗哌卡因在腹横肌平面阻滞中的应用

Dexmedetomidine combined with ropivacaine for ultrasound-guided transversus abdominis plane block

目的观察右美托咪定对罗哌卡因超声引导下腹横肌平面(TAP)阻滞的影响。方法 40例行全子宫+双侧输卵管切除术、美国麻醉医师协会(ASA)分级Ⅰ或Ⅱ级的患者随机分入右美托咪定组和氯化钠组,每组20例,分别予静脉注射0.375%罗哌卡因40mL+右美托咪定1μg/kg和0.9%氯化钠溶液1mL。两组患者在超声引导下行双侧TAP阻滞麻醉,比较两组感觉神经阻滞起效时间、镇痛持续时间和一般生命体征。结果右美托咪定组感觉阻滞起效时间显著短于氯化钠组(P<0.05),而镇痛持续时间显著长于氯化钠组(P<0.05)。右美托咪定组在注射局部麻醉药后10、30min时的平均动脉压显著低于同组用药前和氯化钠组同时间点(P值均<0.05),在注射局部麻醉药后5、10、30、60、120min时的心率均显著慢于同组用药前和氯化钠组同时间点(P值均<0.05)。结论右美托咪定1μg/kg联合罗哌卡因应用于TAP阻滞麻醉中可以缩短感觉阻滞起效时间,并且延长镇痛持续时间。

Objective To evaluate the effectiveness of dexmedetomidine combined with ropivacaine for ultrasound-guided transversus abdominis plane （TAP） block, Methods Forty patients （American Society of Anesthesiologists grade Ⅰ or Ⅱ ） scheduled for complete hysterectomy and bilateral salpingectomy were randomly divided into two groups （n = 20 ）. Ropivacaine 0. 375% （40 mL） plus dexmedetomidine 1 μg/kg （dexmedetomidine group） and 1 mL normal saline （control group） were intravenously injected for ultrasound-guided bilateral TAP block, respectively. Sensory block onset, duration of analgesia and vital signs were compared between the two groups. Results Sensory block onset time in the dexmedetomidine group was significantly shorter than that in the control group （ P〈0. 05）, while the duration of analgesia in the dexmedetomidine group was significantly longer than that in the control group （ P〈0. 05）. Mean arterial pressure at 10 and 30 minutes after TAP block in the dexmedetomidine group were significantly lower than the baseline level and those in the control group at the same time points （all P〈0. 05）. Heart rates at 5,10, 30, 60 and 120 minutes after TAP block in the dexmedetomidine group were significantly less than the baseline and those in the control group at the same time points （all P〈0. 05）. Conclusion Combined application of ropivacaine and 1 μg/kg dexmedetomidine can shorten the onset time and prolong the duration of postoperative analgesia for ultrasound-guided TAP block. （Shanclhai Med J, 2014, 37： 1020-1022）