右美托咪定复合罗哌卡因超前镇痛对全膝关节置换术患者术后镇痛效果的观察

EFFECT OF ADDING DEXMEDETOMIDINE TO ROPIVACAINE FOR PRE-EMPTIVE FOMERAL NERVE BLOCK ON POSTOPERATIVE CONTINUOUS FEMORAL NERVEBLOCK ANALGESIA

目的:观察右美托咪定复合罗哌卡因用于股神经阻滞超前镇痛对全膝关节置换术(TKA)患者术后罗哌卡因连续股神经阻滞镇痛效果的影响。方法:选择拟全麻下行TKA患者30例,随机分为复合组(D组,15例)和罗哌组(R组,15例),D组用0.5%罗哌卡因15mL+右美托咪定0.5μg/kg行股神经阻滞超前镇痛并置管,R组用单纯0.5%罗哌卡因15mL行股神经阻滞超前镇痛并置管,两组术后均使用连续股神经阻滞自控镇痛泵,阻滞药物为0.25%罗哌卡因150mL。记录术后2,4,8,24,48hTKA患者的静息及运动视觉模拟疼痛(VAS)评分,48h内镇痛泵追加次数,术后首次使用曲马多的时间、人数及用量、术后不良反应等。结果:D组各个时间点的静息、运动VAS评分均低于R组,其中术后8,24h两组比较差异有统计学意义(P<0.05);48h内D组镇痛泵追加次数明显低于R组,两组比较差异有统计学意义(P<0.05)。结论:右美托咪定能增强罗哌卡因股神经阻滞超前镇痛后TKA患者术后连续股神经阻滞的镇痛效果。

Objective：To observe the effect of adding dexmedetomidine to ropivacaine for pre-emptive fomer- al nerve block on postoperative continuous femoral nerve block analgesia. Methods： Thirty patients （ASA I, Ii） undergoing general anethesia for Total Knee Arthroplasty （TKA） were divided randomly into two equal groups： Group Composite（group D, 15 cases） and Group Ropivacaine（group R,15 cases）. We did the pre- emptive fomeral nerve block with 0.5% ropivacaine 15ml plus dexmedetomidine 0.5 μg/kg for group D, while with pure 0. 5% ropivacaine 15 mL for group R. Then installed a catheter which connected to the PCA pump（contains 0.25% ropivacaine 150 mL） after surgery. Taking a record of following parameters：2 b,4 h,8 h,24 h,48 h resting VAS score and active VAS score after surgery, PCA pressing times,the first time of using tramadol, dose of tramadol within postoperative 48 h, side effects. Results： The resting and active VAS scores of group D were lower than group R at each time point, and the difference of 8h and 24h between the two groups were significant. PCA pressing times were significantly lower in group D than in group R. Conclusion： Dexmedetomidine could enhanc the analgesic effect of ropivacaine for pre-emptive fo- meral nerve block on postoperative continuous femoral block after total knee arthoplasty.