右美托咪定用于膝关节置换术后硬膜外镇痛的观察

Dexmedetomidine for epidural analgesia after total knee arthroplasty

目的观察并评价右美托咪定联合吗啡和左旋布比卡因用于膝关节置换术后患者自控硬膜外镇痛(PCEA)的效果。方法将择期行膝关节置换术患者60例按随机数字表法分为3组,每组20例。M1组:PCEA配方为吗啡2mg+左旋布比卡因150mg+0.9%氯化钠溶液共100ml;M2组:PCEA配方为吗啡4mg+左旋布比卡因150mg+0.9%氯化钠溶液共100ml;DM组:PCEA配方为吗啡2mg+左旋布比卡因150mg+右美托咪定1.5μg/kg+0.9%氯化钠溶液共100ml。分别于术后1、4、8、12、24、40h时记录静息痛和活动痛的视觉模拟评分(VAS),记录术后4及24h平均动脉压与心率,并观察有关不良反应发生情况。结果与M1组相比,DM组术后不同时点静息痛和活动痛的VAS评分较低(均P<0.05),DM组的恶心、头晕和尿潴留的发生率较低(P<0.05);与M2组相比,DM组术后不同时点静息痛和活动痛的VAS评分差异均无统计学意义(均P>0.05),DM组的恶心、呕吐、头晕、皮肤瘙痒和尿潴留的发生率均减低(均P<0.05);3组未见硬膜外镇痛有关低血压、心动过缓。结论右美托咪定混合吗啡和左布比卡因用于膝关节置换术后PCEA效果好,减少吗啡用量,血流动力学稳定,不良反应少。

Objective To evaluation the efficacy of dexmedetomidine mixed with morphine and levobupivacaine for patient-controlled epidural analgesia(PCEA)after total knee arthroplasty(TKA). Methods ASixty patients of ASA I or II aged 55-75 undergoing elective total knee arthroplasty under epidural anesthesia were randomly divided into 3 groups(n=20 each):in group M1,PCEA solution contained morphine 2mg+levobupivacaine 150mg+normal saline 100ml;in group M2,PCEA solution contained morphine 4mg+levobupivacaine 150mg+normal saline 100ml and in group DM,PCEA solution contained morphine 2mg+levobupivacaine 150mg+dexmedetomidine 1.5μg/kg+normal saline 100ml.The scores of visual analog scale(VAS)were recorded during rest and movement at 1,4,8,12,24 and 40 h after operation;the mean arterial pressure(MAP)and the heart rate(HR)were recorded at 4 and 24h after operation.The epidural analgesia-related side effects were also documented. Results Compared to group M1,the VAS scores during rest and movement in group DM were significantly lower than those in group M1(P<0.05);the incidence of nausea,dizziness and urinary retention was also lower in group DM(P<0.05).There was no significant difference in VAS scores between group DM and group M2(P>0.05),but the incidence of nausea,vomiting,dizziness,pruritus and urinary retention was significantly lower in group DM than that in group M2(P<0.05).No patients developed epidural analgesia-related hypotension,bradycardia in all three groups. Conclusion The efficacy of dexmedetomidine mixed with morphine and levobupivacaine for patient-controlled epidural analgesia after total knee arthroplasty is satisfactory with less morphine administrated,stable hemodynamics and fewer side effects.