右美托咪定联合超声引导下罗哌卡因腹横肌平面阻滞对经腹子宫全切术后镇痛效果的评价

Evaluation on the postoperative analgesic effect of dexmedetomidine combined with ropivacaine for ultrasound guided transversus abdominis plane block after abdominal uterine surgery

目的探讨右美托咪定联合超声引导下罗哌卡因在腹横肌平面阻滞对经腹子宫切除术患者术后镇痛效果的影响。方法择期行经腹全子宫切除术患者60例,ASA分级Ⅰ或Ⅱ级,随机分为两组:右美托咪定联合罗哌卡因组(DEX)和对照组(CON),每组30例。手术结束后两组患者在超声引导下行双侧腹横肌平面阻滞,DEX组予右美托咪定1μg/kg+0.25%罗哌卡因至40 ml,CON组予0.25%罗哌卡因40 ml,每侧20 ml。术后均行患者静脉自控镇痛,比较两组术后2、6、12、24、48 h静息及活动时VAS疼痛评分、Ramsay镇静评分,记录术后24 h和48 h内阿片类药物用量及镇痛相关不良反应发生的情况。结果两组患者在术后各时间段静息和活动下VAS评分未见明显差异,Ramsay评分在2 h、6 h、12 h DEX组明显高于CON组(P<0.01);DEX组术后24 h和48 h阿片类镇痛药物用量显著降低(P<0.001),恶心呕吐发生率明显低于CON组(P<0.05)。结论经腹子宫全切除术患者,右美托咪定1μg/kg联合罗哌卡因应用于双侧腹横肌平面阻滞,显著降低了术后阿片类药物用量,增强了术后镇痛效果,促进术后恢复。

Object To evaluate the postoperative analgesic efficacy of dexmedetomidine combined with ropivacaine for ultrasound guided transversus abdominis plane block after abdominal uterine surgery. Methods Sixty patients,ASAⅠ- Ⅱ,underwent abdominal uterine surgery were randomized into the dexmedetomidine group（Group DEX） and the control group（Group CON）. All patients（Group DEX with dexmedetomidine 1 μg/kg＋0.25% ropivacaine to 40 ml and Group CON with 0.25% ropivacaine 40 ml）received ultrasound-guided bilateral TAP block after operation, 20 ml for each side. All patients assessed with Ramsay scores and the pain with VAS score at rest and on movement at 2, 6, 12, 24 and 48 hours after operation. The opioid requirement at 24 h and 48 h postoperatively, and the incidence of opioid related side-effects after operation were also recorded. Results There was no difference between the two groups on VAS score at rest and on movement at different time points after surgery. And Ramsay scores were much higher in Group DEX than in group CON 2, 6 and 12 hours postoperatively（P〈0.01）. Opioid consumption at 24 h and 48 h after surgery in Group DEX was significantly lower than that of Group Con（360.4±117.1 vs. 572.3±132.4μg; 712.1±184.1 vs. 1022.2±197.6; P〈0.001）. The incidence of nause and vomiting postoperatively was much higher in Group Con than in Group DEX. Conclusion Combined ropivacaine and 1μg/kg dexmedetomidine for ultrasound guided bilateral TAP block can reduce postoperative analgesic requirement after abdominal uterine surgery, which can enhance analgesic efficacy and promote postoperative recovery.