七氟醚麻醉下右美托咪定复合罗哌卡因行髂腹下/髂腹股沟神经阻滞的效果

Effect of dexmedetomidine combined with ropivacaine for ilioinguinal and iliohypogastric nerve block under sevoflurane anesthesia

目的观察七氟醚麻醉下右美托咪定复合罗哌卡因行髂腹下/髂腹股沟神经阻滞在老年患者腹股沟疝手术中的效果。方法选择择期行腹股沟无张力疝修补术老年男性患者60例,年龄65~75岁,体重55~75kg,ASAⅠ或Ⅱ级。采用随机数字表法将患者分为右美托咪定组(D组)和对照组(C组),每组30例。患者术中吸入七氟醚,保留自主呼吸,并行超声引导下髂腹下/髂腹股沟神经阻滞,其中D组为右美托咪定1μg/kg+0.375%罗哌卡因20ml,C组为0.375%罗哌卡因20ml。记录感觉阻滞起效时间及镇痛持续时间,观察术后不良反应的发生情况。结果 D组感觉阻滞起效时间明显短于C组[(10.6±4.3)min vs(14.4±5.1)min,P<0.05],镇痛持续时间明显长于C组[(832.7±136.6)min vs(669.8±140.1)min,P<0.05]。D组术中有2例(6.7%)患者发生心动过缓。术后所有患者均未发生麻醉相关不良反应。结论右美托咪定复合罗哌卡因应用于超声引导下髂腹下/髂腹股沟神经阻滞可缩短感觉阻滞起效时间,延长术后镇痛持续时间。

Objective To investigate the clinical efficacy of dexmedetomidine combined with ropivacaine for ilioinguinal and iliohypogastric nerve block in elderly patients undergoing inguinal hernia surgery.Methods Sixty elderly patients undergoing inguinal hernia surgery were randomly divided into dexmedetomidine group（group D）and control group（group C）,30 patients in each group.All patients received ilioinguinal and iliohypogastric nerve block by the same anesthesiologist.0.375%ropivacaine and dexmedetomidine 1μg/kg 20 ml were used in ilioinguinal and iliohypogastric nerve block in group D,while 0.375%ropivacaine 20 ml were used in ilioinguinal and iliohypogastric nerve block in group C.Sensory block onset time and blockade duration were recorded.Side effects were recorded in both groups.Results Sensory block onset time in group D was significantly shorter than that in group C（10.6±4.3min vs 14.4±5.1 min,P〈0.05）.Sensory block durations in group D was significantly longer than that in group C（832.7±136.6 min vs 669.8±140.1 min,P〈0.05）.There were two bradycardia cases in group D.No adverse reactions or anaesthesia complications occurred in all patients following postoperative follow-up.Conclusion Dexmedetomidine combined with ropivacaine can be used in ilioinguinal and iliohypogastric nerve block safely,and dexmedetomidine shortens the onset time and prolonged the duration of sensory block.