右美托咪定复合罗哌卡因在超声引导下腹横肌平面阻滞中的应用

Ultrasound-guided transversus abdominis plane block with dexmedetomidine combined with ropivacaine

目的观察右美托咪定复合罗哌卡因在超声引导下腹横肌平面阻滞中的作用。方法选择择期行疝囊高位结扎、疝后壁修补术的老年男性患者40例,年龄60~80岁,随机均分为两组:对照组(C组)和右美托咪定组(D组),每组20例。全身麻醉,予丙泊酚及瑞芬太尼微量泵静脉输注维持麻醉。手术结束后采用超声引导下后路腹横肌平面阻滞(transversus abdominis plane block,TAPB),C组患者每侧使用0.2%罗哌卡因20ml,D组患者每侧使用0.2%罗哌卡因20ml(含0.5μg/kg右美托咪定)。监测术后1、3、6、12、18小时各时点静息和运动疼痛视觉模拟评分(visual analogue scale,VAS),记录术后各时点阿片类药物曲马多用量。结果 C组患者术后1、3、6、12、18小时各时点静息状态VAS评分明显高于D组,差异有统计学意义(P<0.05);运动状态下VAS评分两组差异均无统计学意义(P>0.05)。术后1~6小时,C组患者曲马多使用量明显高于D组,差异有统计学意义(P<0.05);术后12小时两组患者曲马多使用量差异均无统计学意义(P>0.05);术后18小时两组患者均未使用曲马多。结论右美托咪定复合罗哌卡因用于超声引导下TAPB,能为老年疝手术患者提供更为完善的术后镇痛。

Objective To observe the effects of dexmedetomidine combined with ropivacaine on ultrasound-guided transversus abdominis plane （TAP） block in elderly male patients undergoing inguinal hernia surgery. Methods Forty patients （60-80 years of age） undergoing inguinal hernia surgery were randomly divided into two groups： control group （group C） and dexmedetomidine group （group D）. All patients received general anesthesia, followed by maintenance anesthesia with intravenous infusion of propofol and remifentanil. After operation, patients received unilateral ultrasound-guided TAP block with 0.2% ropivacaine 20ml in group C and unilateral ultrasound-guided TAP block with 0.5ttg/kg dexmedetomidine combined with 0.2% ropivacaine 20ml in group D. The resting and moving visual analogue scale （VAS） scores and tramadol consumption were recorded at 5 time points after operation： lh, 3h, 6h, 12h, 18h. Results The resting VAS scores in group C were significantly higher than those in group D at any time point（P〈 0.05） There was no difference in the moving VAS scores between two groups at any time point （P〉 0.05）. Tramadol consumption of 1-6h after operation in group C was significantly larger than those in group D（P〈0.05）. And there was no difference in tramadolconsumption at 12h after operation between two groups （P〉 0.05）. At the time point of 18h, there was no tramadol consumption in two groups.Conclusion Dexmedetomidine combined with ropivacaine during ultrasound-guided TAP block tends to increase the analgesic effects on elderly patients undergoing inguinal hernia surgery.