右美托咪定混合罗哌卡因应用于腹横肌平面阻滞在腹腔镜斜疝修补术中的镇痛镇静疗效

Analgesic and sedative effect of dexmedetomidine mixed with ropivacaine for transversus abdominis plane block on laparoscopic inguinal hernia repair

目的探讨和评估右美托咪定作为局麻药佐剂行腹横肌平面(transversus abdominis plane,TAP)阻滞在腹腔镜斜疝修补术中的镇痛镇静疗效。方法选择同济大学附属东方医院2017年3月至7月90例择期拟行全麻下腹腔镜斜疝修补术的患者,年龄20~75岁,ASA分级Ⅰ~Ⅱ级,随机分为全麻组(G组,n=30),0.25%罗哌卡因每侧20 mL神经阻滞+全麻组(R+G组,n=30),右美托咪定0.5μg/kg+0.25%罗哌卡因每侧20 mL神经阻滞+全麻组(DR+G组,n=30)。R+G组和DR+G组于全麻诱导前超声引导下实施双侧TAP阻滞。记录3组术后24 h镇痛、镇静评分、全麻自主呼吸恢复时间、拔除气管导管时间、入苏醒室后Steward评分、术后24 h内恶心呕吐发生情况、呼吸抑制、辅助镇痛使用情况、TAP阻滞和右美托咪定相关不良反应发生情况。结果DR+G组镇静评分(Ramsay)、镇痛评分(numerical rating scale,NRS)明显低于其他两组(P<0.05),且有效镇痛时间延长;和G组相比,R+G组和DR+G组术后苏醒时间、自主呼吸恢复时间、拔管时间明显缩短,Steward评分显著降低(P<0.05);与其他两组比较,DR+G组呼吸抑制发生率明显降低(P<0.05)。结论小剂量右美托咪定作为局麻药佐剂应用于腹横肌平面阻滞联合全麻下腹腔镜斜疝修补术安全有效,术后有效镇痛时间明显延长,恶心呕吐、呼吸抑制等不良反应发生率明显降低。

Objective To investigate and evaluate analgesic and sedative efficacy of dexmedetomidine as an adjuvant to local anesthetics for transversus abdominis plane （TAP） block in the patients undergoing laparoscopic inguinal hernia repair. Methods From Mar.to Jul., 2017, 90 patients under general anesthesia for elective laparoscopic inguinal hernia repairment, in East Hospital, Tongji University, aged 20-75 years old with ASA of Ⅰ-Ⅱ. All patients were randomized into 3 groups （n=30 for each） using a random number table： general anesthesia group （group G）, 0.25% ropivacaine for TAP block ＋general anesthesia group （group R＋G）, and dexmedetomidine 0.5 μg/kg mixed with 0.25% ropivacaine for TAP block ＋ general anesthesia group （group DR＋G）. Before anesthesia induction, ultrasound guided two sides TAP block was performed in R＋G and DR＋G groups. The following parameters of 3 groups 24 h after the operation were recorded：Ramsay score and numerical rating scale （NAS）, the time for recovery of spontaneous breathing, the time for tracheal extubation, Steward score, postoperative nausea and vomiting （PONV） respiratory depression, excessive sedation, the TAP block and dexmedetomidine related adverse events. Results Ramasy score and NAS in DR＋G were significantly improved （P〈0.05）, and significantly prolonged analgesic effect. The emergence time for recovery, spontaneous breathing and tracheal estuation in group R＋G and group DR＋G were significantly shortened （P〈0.05）, and Steward score were significantly lower （P〈0.05）. Compared with the other two groups, the incidence of respiratory depression was significantly decreased in group DR＋G （P〈0.05）. Conclusions Low-dose dexmedetomidine as an adjuvant to ropivaca for TAP block in the patients undergoing laparoscopic inguinal hernia repair combined with general anesthesia is safe and effective, which enhances the analgesic effect, prolongs analgesic duration and provides faster postoperative recovery.