右美托咪定复合罗哌卡因及吗啡关节腔周围注射对前交叉韧带重建术后镇痛效果观察

目的观察右美托咪定复合罗哌卡因及吗啡应用于关节腔周围注射对前交叉韧带重建术术后镇痛效果及其安全性。方法：全麻下行前交叉韧带重建术患者60例，按双盲法随机分为三组，每组20例。M组注射盐酸罗哌卡因＋吗啡，D组注射盐酸罗哌卡因＋右美托咪定，DM组注射盐酸罗哌卡因十吗啡＋右美托咪定。镇痛药物由手术医师在手术结束皮肤缝合前向关节腔周围滑膜组织、取腱处及各个切口周围各注射。结果：D组、M组和DM组用药总量分别为1200、1000 mg和600 mg，用药总量对比无统计学差异。使用镇痛药人数在7-12 h时间段DM组明显少于D组、M组（P〈0．05），在D组和M组问两组额外使用镇痛药人数没有统计学差异。3组无术后并发症。结论：右美托咪定和罗哌卡因关节腔周围注射与吗啡和罗哌卡因关节腔周围注射用于前交叉韧带重建术后镇痛效果相似。关节腔周围注射右美托咪定复合罗哌卡因及吗啡用于前交叉韧带重建术后镇痛效果更佳。

Objective To as sess the analgesic effect and safeness of periarticular injection by using dexmedetomidine morphine andropivacaine after anterior cruciate ligament reconstruction. Methods： Choose 60 patients who have done anterior cruciate ligamentreconstruction with hamstring autograft （gracilis and semitendinosus） under ASA I-II general anesthesia and randomly divided these patientsinto three groups as per double-blind study, with 20 patients in each groups. Group M, patients received morphine＋ropivacaine before woundclosure; group D, patients received dexmedetomidine ＋ropivacaine; group DM, patients received morphine ＋dexmedetomidine ＋ropivacaine.Result： Total consumption of tramadol were： group D 1200 mg, group M 1000 mg, group DM 600 mg, there were no significantly differ amongthree groups. Compared with group DM, the amount the patients taking the tramadol was less significantly at time frame 7-12 hours afteroperationin group D （P=0.012）and group M （P=0.03）, but there was no statistics significant between group D and group M.There were nocomplication in three groups.Conclusion：Analgesic effect of periarticular injection of ropivacaine mixed with dexmedet0midine or morphineafteranterior cruciate ligament reconstruction were similar. The Analgesic effect of periarticular injection compound dexmedetomidine, morphine andropivacaineafter anterior cruciate ligament reconstruction was much better than the others.