右美托咪定不同给药途径用于全膝关节置换术后镇痛的效果

Effects of different administration routes of dexmedetomidine on postoperative analgesia after total knee arthroplasty

目的评估右美托咪定不同给药途径应用于全膝关节置换术患者术后镇痛的临床效果。方法选择在全麻下行单侧全膝关节置换术患者90例, ASAⅠ～Ⅱ级,随机分成为三组,每组30例。A组:右美托咪定混合罗哌卡因股神经阻滞+舒芬太尼静脉自控镇痛; B组:罗哌卡因股神经阻滞+右美托咪定混合舒芬太尼静脉自控镇痛; C组:罗哌卡因股神经阻滞+舒芬太尼静脉自控镇痛。三组患者手术结束后送至麻醉恢复室,给予股神经阻滞联合静脉自控镇痛泵进行术后镇痛,维持术后静息视觉模拟量表(VAS)评分≤3分。分别于术后第6、 12、 24、 48 h记录患者静息、屈膝VAS评分及Ramsay镇静评分。当静息VAS评分> 3分时,通过按压静脉镇痛泵及静脉推注帕瑞昔布进行镇痛补救。观察并记录三组术后48 h内帕瑞昔布总剂量、静脉镇痛泵有效按压次数和持续使用时间,以及不良反应发生情况。结果三组术后各观察时点静息和屈膝VAS评分以及Ramsay镇静评分比较均无显著差异(P> 0.05)。与C组比较, A、 B两组术后48 h内帕瑞昔布总剂量减少,静脉镇痛泵有效按压次数减少、持续使用时间延长,差异有显著意义(P <0.05); A、 B两组术后48 h内帕瑞昔布总剂量、静脉镇痛泵有效按压次数和持续使用时间无显著差异(P> 0.05)。术后48 h内B组心动过缓发生率为20%(6/30),高于A组(3%, 1/30, P <0.05)。结论对于全膝关节置换术患者,右美托咪定混合罗哌卡因股神经阻滞联合舒芬太尼静脉自控镇痛泵,术后镇痛效果好,不良反应少,适合临床应用。

AIM To observe the effects of different administration routes of dexmedetomidine on postoperative analgesia in patients with total knee arthroplasty.METHODS Ninety patients undergoing unilateral total knee arthroplasty were enrolled and their ASA grade was Ⅰ-Ⅱ.The patients were randomly divided into three groups（n = 30）： ropivacaine mixed dexmedetomidine for femoral nerve block combined with sufentanil in patient controlled intravenous analgesia（ PCIA） pump（ group A）,ropivacaine for femoral nerve block combined with sufentanil mixed dexmedetomidine in PCIA pump（group B）,ropivacaine for femoral nerve block combined with sufentanil in PCIA pump（group C）.The patients in three groups were sent to the post anesthesia care unit and given the femoral nerve block combined with PCIA in order to maintain postoperative resting VAS score ≤ 3.At 6,12,24,48 hours after surgery,resting,kneeling VAS score,and Ramsay score were recorded.When patients with resting VAS score 3,parecoxib was intravenous injected and PCIA was pressed.The consumption of parecoxib within 48 hours after surgery,continuous time of the use PCIA and the PCIA pressing frequencies were recorded.At the same time,adverse reactions were recorded.RESULTS There were no significant differences in resting,kneeling VAS score,and Ramsay score among three groups（P 0.05） at6,12,24,48 hours after surgery.Compared with group C,the consumption of parecoxib within 48 hours postoperatively was decreased,while continuous time of the use PCIA was prolonged and the PCIA pressing frequencies were decreased in the group A and group B（ P 0.05）.Compared with group B,there was no significant difference in consumption of parecoxib within 48 hours postoperatively,continuous time of the use PCIA and the PCIA pressing frequencies in group A（P 0.05）.The incidence of bradycardia in the group B was 20%（6/30） within 48 hours after surgery,which was higher than that in the group A（3%,1/30,P 0.05）.CONCLUSION Ropivacaine mixed dexmedetomidine for femoral nerve block combined with sufentanil PCIA pump applied in total knee arthroplasty patients has good postoperative analgesia effect with fewer adverse reactions,so it is suitable for clinical application.