盐酸右美托咪定复合罗哌卡因在腹横肌平面阻滞中的术后镇痛效果

Dexmedetomidine Added to Ropivacaine Extends the Duration of Transversus Abdominis Plane Blocks When Compared with Ropivacaine Alone

目的观察盐酸右美托咪定复合罗哌卡因在腹横肌平面(transversus abdominis plane,TAP)阻滞中的安全性及镇痛效果。方法选择60例行腹部手术的患者,随机分为两组,每组30例。两组患者术毕均行超声引导TAP阻滞,罗哌卡因组双侧腹部各给予0.375%罗哌卡因10m L,盐酸右美托咪定组给予0.375%罗哌卡因10 ml复合75μg盐酸右美托咪定。所有患者均未使用术后静脉镇痛泵。记录两组患者术后镇痛作用时间,术后2、4、6、12和24h视觉模拟疼痛(VAS)评分,不良反应及腹横肌平面阻滞操作相关并发症。结果盐酸右美托咪定组患者的镇痛时间长于罗哌卡因组(P<0.05);盐酸右美托咪定组术后12h内疼痛评分心率及术后120min平均动脉血压均低于罗派卡因组(P<0.05);两组均未见严重不良反应及TAP穿刺引起的并发症。结论盐酸右美托咪定复合罗哌卡因可增加TAP阻滞镇痛作用时间,改善病人术后疼痛。

Objective To observe the safety and analgesic effect of dexmedetomidine combined with ropivacaine in transversus abdominis plane（TAP）block. Methods 60 patients undergoing elective lower abdomen gynecological surgery under general anesthesia were enrolled and randomly divided into two groups（group A vs group B）. The patients in group B underwent ultrasound-guided TAP block with 10 m L of 0.375% ropivacaine after surgery while the patients in group A received 10 m L of 0.375% ropivacaine plus 150 mg dexmedetomidine under ultrasound-guided TAP block postoperatively. All patients did not use analgesia pump postoperatively.Postoperative analgesic action of time,2,4,6,8,12 and 24 hour visual analogue score（VAS）and adverse effects as well as related complications of TAP were recorded. Results The median duration of the TAP block was 17 hours（95% confidence interval,17-20）in group A and 13 hours（95% confidence interval,13-18）in group B（P〈0.05）. Dexmedetomidine also decreased significantly pain scores for the first 12 hours postoperatively（P〈0.05）. Decrease in heart rate and the mean artery blood pressures at 120 minutes postoperative were different significantly in the group A when compared with the ropivacaine group B. There were no adverse events or complications of TAP puncture. Conclusion Dexmedetomidine combined with ropivacaine for TAP blocks increased the duration of the nerve block and improved postoperative pain.